Application for interior designer account
Company name
Contact name Title
Billing address
City State Zip
Shipping address
City State Zip
Phone Fax
Email (required) Website
Credit card information Visa Mastercard American
Card number Expiration
Name on card Signature
I would like to open
Designer Account (20% off retail price)*
*Once your account is established, you will be notified via email and may place orders by fax at 415-331-1435.
How did you hear about us?
How many years in business?
Please attach a copy of your ASID certification and/or tax ID along with your completed application.
10 Liberty Ship Way, Suite 350 Sausalito, CA 94965 P 415-331-4364 F 415-331-1435 www.serenaandlily.com