Catalog Request

Thank you for your interest in receiving a Country House Collection catalog. You must own a retail store to purchase from us. We do not sell wholesale to private individuals. All fields must be filled in to request a catalog. We may require additional information before sending you a catalog.

If you are currently not a Country House Collection customer and would like to become one, Click Here to apply for an account.

  
 

Customer Information

             
Customer ID:   If a new Customer, Please leave blank
Company Name:
Tax Id:

Billing/Mailing Information - Address must qualify for delivery by United States Postal Service

SALUTATION:
First Name:
MI:
Last Name:
Title:
Street Address:
Street Address2:
City:
State:
Zip Code:
Phone:       Ext:  
Fax:      
Email Address:

Shipping Address Information - This address must be a physical location

   
Shipping Street Address:
Shipping Street Address2:
Shipping City:
Shipping State:
Shipping Zip Code:

Business Information

Type of Business:
Years in Business:
Number of Stores:
Products you Carry:
How Did You Hear About Us:
Type the characters shown in the image for verification: