Regency House - Account Application

Account Application

	PROFESSIONAL ORGANIZATION
Date
Name of Account
Principal(s)
Billing Street Address
City:
State
Zip
Phone
Email
Fax
Business Certification	Contract Specifier Architect Residential Designer Design Firm Department Store Other Explain:
Check one	Proprietorship Partnership Corporation
Date Business Started
	RESPONSIBILITY FOR PAYMENT
Firm Name
Address
City
State
Zip
Phone
Fax
Contact Person
	PROFESSIONAL EXPERIENCE OF PRINCIPAL(S) (Residential Accounts Only)
Firm
Address
City
State
Zip
Phone
Contact
Date of Service
	PROFESSIONAL EXPERIENCE OF PRINCIPAL(S) (Residential Accounts Only)
Firm
Address
City
State
Zip
Phone
Contact
Date of Service
Check all affiliations	ASID NHFL AIA IBD NEWH Other:
	CREDIT INFORMATION
Type of Account Requested	Open Terms -(Bank Credit Information form will be mailed to you for completion and signature) Proforma-CBD

Please provide account numbers for those firms in this industry with which you have open credit status
American Textiles		Jack Lenor Larsen
ARC-COM Fabrics		Knoll
B Berger		Kravet Fabrics
Bailey & Griffin		Lee Jofa
Ben Rose		Maharam Fabrics
Brickel		Norbar Fabrics
Manuel Canovas		Osborne & Little
Carnegie Fabrics		Payne & Co
Clarence House		Pindler & Pindler
Cowtan & Tout		Scalamandre
Decorators Walk		Stark
Design-Tex Fabrics		Steelcase
Donghia		Stroheim & Romann
Duralee Fabrics		Unika-Vaev
F. Schumacher		Westgate
Herman Miller
Hinson & Company
J. Robert Scott
Additional Credit Information

	ADDITIONAL INFORMATION
Bank Reference
Bank Address
Bank Account #
Dun & Bradstreet #
State Sales Tax #
Signature: Date:	____________________________________________________ __________________

Thank you for your application. Please mail or fax signed application and completed state tax certificate. Address: Regency House Imports, PO Box 883814, San Francisco, 94188-3814 Fax: 650-345-7824

You will receive an acknowledgement via email and your application will be reviewed .

Back to Order Page>>