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:*