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Company Name: *
Contact's First Name: *
Contact's Last Name: *
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Phone: *
Fax:
Email: *

Type of establishment (Select all that apply)
Hotel:     Motel:     Hospital:     ALF/Nursing Home:     Time Share/Rental Apt:
Other:

Number of Rooms
1- 49     50 - 74     75 - 100
101 - 200     200 +     N/A

Are you affiliated with a chain/hotel franchiser?
Yes     No
If yes, which one?
Do you use a designer?
Yes     No
If yes, which one?
Do you use a purchasing agency?
Yes     No
If yes, which one?
Are you affiliated with a Management Company?
Yes     No
If yes, which one?
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70 N.W. 25th Street • Miami Florida 33127
Phone: 305-576-2690 • Fax: 305-576-1048