Owner First Name

Owner Last Name

Email

Fax

Phone

Mobile Phone

Address

Address Line 2

City

State StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

Company information Company information

Legal Business Name

DBA (Doing Business As)

Company Website

Sales Tax Certificate #

Number of Stores

Average Size of Store(s) (sq. ft)

Type of Business Type of BusinessBrick & Mortar Only – Single LocationBrick & Mortar Only – Multiple LocationsRent to OwnDesigner/StagerDistributorLiquidatorWarehouse/ClubOther

Type of Products Selling (please check all that apply) Type of Products Selling (please check all that apply) Furniture Mattresses Electronics/Appliances Other

Years in Business Years in BusinessLess Than 11-22-55-10More Than 10

Annual Sales Volume Annual Sales Volume Less than $500K$500K - $1M$1M - $4.99M$5M - $19.99M$20M +

Other Furniture Brands You Represent

Nearest Distribution Center Nearest Distribution CenterSouthern California (12909 Sandoval Street, Santa Fe Springs, CA 90670)*Northern California (9698 West Sugar Road, Tracy, CA 95304)Illinois (1550 Central Ave, Roselle, IL 60172)Texas (14901 Grand River Road, Fort Worth, TX 76155)New Jersey (45 Stuits Rd, Suite 2, Dayton, NJ 08810)Georgia (4300B South Fulton Parkway, Union City, GA 30349)Florida (10700 Enterprise Way, Miramar, FL 33025)

Industry Memberships (please check all that apply) Industry Memberships (please check all that apply) BrandSource HFA FMG Furniture First Nationwide TRIB IAHSP RESA Other

Company distribution channels Company distribution channels

Online Marketplace(s) You Sell On (please check all that apply) Online Marketplace(s) You Sell On (please check all that apply) Amazon Walmart Jet.com Ebay Etsy Google Shopping Sears Marketplace Overstock.com NewEgg.com Rakuten Other

Percentage of Business Through Ecommerce (%)

Other Ecommerce Sites You Sell On (i.e. non-marketplace(s))

Marketing Strategy

Do you handle freight to consumers? Do you handle freight to consumers? Yes No

Notes/Comments