Thank you for purchasing BR-111’s exotic hardwood flooring display. It is essential that
you take a moment to complete the following registration form. Information from this
form will be used to link your store to the
B R -111
™
web site and help generate valuable
on-line referrals in our “Find A Dealer” section.
Please fax or mail to the
B R -111
™
address listed at the bottom of this page. Or register
on-line through the “Dealer Services” section.
Date: ______________________
Dealer: _______________________________________________________________________
Address: ______________________________________________________________________
City: _________________________________________________________________________
State: ______________________________________________ ZIP: _____________________
Contact/Owner: _______________________________________________________________
Phone: _________________________________ Fax: _________________________________
Web Site: _____________________________________________________________________
E-Mail: ________________________________________________________________________
Other Manufacturers Displayed In Store:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Percentage of Business That is Wood Flooring:________________
Distributor:____________________________________________________________________________________________
Distributor Rep Name: __________________________________________________________________________________
Contact Number: ______________________________________________________________________________________
Which BR-111
™
Sample Packages Do You Have?:
❏ 1
BR-111
™
Indusparquet
®
❏ 2
BR-111
™
Indusparquet
®
❏ 3
Casanova Engineered
❏ 4
BR-111
™
Engineered
3/4" Prefinished Solid 5/16" and 7/16" Prefinished Solid 3/8" Prefinished 5/16" Prefinished
8/30/04
107
12800 NW 107th Court
•
Medley, Florida 33178
•
(800) 525-BR111(2711)
•
Fax (800) 577-2711
•
www.br111.com
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