Please Complete The Form Below: There is a fully-refundable charge of $75 for each company checked; with your first order of $750 or more, please take a one-time credit of $75 and you have your money back! You will receive an email confirmation after our area representative has reviewed your application. Once confirmed you will be eligible to participate in our brand new AUCTION program. Required fields are in red

Please Select the Company(s) You Are Appling For	Michael Thomas Miles Talbott
Your Company Name
Shipping Address (for packages)	(address) (city) (state) (zip)
Mailing Address (If different)	(address) (city) (state) (zip)
Your Name
Your E-mail Address
Business Telephone
Business Fax
Cell Phone
Tax Number & State	(number) (state)

All credit information will be held in strict confidence, and no information will be exchanged with any other party. Please fax you credit information and credit card data to: Lila Gunn, Corporate Controller Michael Thomas Furniture (336) 622-4112 Many thanks for your interest in our company; we will work hard to to make you look good to your clients. Tom Jordan, President Michael Thomas Furniture, Inc