Membership Form

Instructions

Please fill in the form below then click the Review button at the bottom of the form. Required fields are labeled with a " * ".

Fill in as many of the optional fields as you can. If you are updating an existing listing then fill in the fields that need updating.

Company Name and Email address is always required. We respect and protect our members privacy. We will NEVER use your email address for any reason other than to communicate with you about your membership.

Company Name *

Email *
Enter an email address so we can contact you.

New Member ?
Are you a new member or are you updating your existing membership?

Yes No

Dealer Type

Store
Shop At Home
Commercial Contractor

Address
Enter your complete address.

Address:
City:	, WA Zip:

Phone
Enter up to 2 phone numbers.

Website
Enter your website address if you have one.

Products
Select the products you sell.

Carpet
Area Rugs
Hardwood

Laminate
Resilient
Tile

Service Area
For shop-at-home and commercial contractors only. Select the counties you service.

Adams
Asotin
Benton
Chelan
Clallam
Clark
Columbia
Cowlitz
Douglas
Ferry
Franklin
Garfield
Grant

Grays Harbor
Island
Jefferson
King
Kitsap
Kittitas
Klickitat
Lewis
Lincoln
Mason
Okanogan
Pacific
Pend Oreille

Pierce
San Juan
Skagit
Skamania
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima

Affiliations
Select any affiliations (trade groups, authorized dealer, etc.)

Abbey Carpet
Beaulieu
Carpet One
Flooring America
Floors To Go
Karastan
Mohawk
StarNet Commercial Flooring Cooperative
Washington State Floor Covering Association

Comments
Enter any comments and additional information.