To Request that You Are Considered as a Timeless Collection™ Installer, Please Fill This Form Out Completely and You Will Be Contacted by a Timeless Collection™ Representative.

COMPANY NAME*
COMPANY CONTACT PERSON
COMPANY ADDRESS*

STREET:

TOWN*: STATE*:

PHONE NUMBER (WITH MESSAGE SERVICES)*

- -

OFFICE PHONE CELL PHONE
YEARS IN FLOORING BUSINESS
 LESS THAN 1 YR
1-2 YEARS 		2-10 YEARS
MORE THAN 10 YRS
AREA YOU SERVICE
AVERAGE PER SQUARE FOOT PRICE YOU CHARGE FOR INSTALLING PLANK FLOORING
 $
EMAIL ADDRESS*

REFERENCES*

PROVIDE ATLEAST 3, WITH THEIR PHONE NUMBERS.

PROVIDE PHOTOS OF THE JOBS, IF POSSIBLE, IN THE FIELD BELOW.
JOB PHOTOS (.jpg or .tiff files)
  * REQUIRED INFORMATION