CUSTOMER TYPE *
Company Resale Number Palecek Customer Number
         
( * Indicates Required Field)  
  GENERAL INFO
FIRST NAME * LAST NAME * JOB TITLE COMPANY NAME *
STREET ADDRESS *  CITY *
STATE * ZIP  * 
COUNTRY
PHONE* EMAIL * CONFIRM EMAIL * WEBSITE 
  FOR RETAILERS
Do you have a retail store front?
How many locations?
If you are a retailer, what do you sell?
 
How did you hear about Palecek?
 
  FOR DESIGNERS
What best describes your business?
Do you purchase for your clients?
What best describes your clients?
 
Does your design business have a store front?
How many locations?
How did you hear about Palecek?
 
  HOSPITALITY INDUSTRY
How did you hear about Palecek?
  Sales Rep  
What best describes your business?
  Designer  
What best describes your clients?
  Hotel  
  INDIVIDUAL CONSUMER
How did you hear about Palecek?
  Sales Rep  
  * This website is for the trade only. Please contact us if you have any questiions or for local purchasing options at info@palecek.com.
  FOR ONLINE RESELLERS
What is your business focus?
How did you hear about Palecek?
 
  FOR WHOLESALERS
What is your business focus?
 
How did you hear about Palecek?
 
  FOR MAIL ORDER CATALOGS
What is your business focus?
How did you hear about Palecek?
 
Catalog Titles:       
 
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