Distinctive Designs

We're excited that you are interested in becoming one of our many satisfied customers!

Please complete the form below to receive a customer login for our site, and become eligible for discounts on most products.

Soon after, you will receive an email with your activated username and password

Required fields are marked in bold.

First Name:

Last Name:

Title:

(e.g., Merchandise Buyer)

Company Name:

Bill-To Address 1:

Bill-To Address 2:

City:

State/Province (U.S./Canada only):

Other:

Postal Code:

Country:

Phone:

Fax:

Email:

(once approved, your password will be sent to this address)

DBA (Doing Business As):

Tax ID #:

Gains #:

(if available)

Lyons #:

(if available)

Customer Type:

If Other, please specify:

Local Zip Codes:

If you would like to be included on the 'Dealer Locator' area of our web site, please enter up to five local zip codes to which you provide service.
1. 2. 3.
4. 5.

How did you hear about our web site:

If Other, please specify:

Feel free to add any special
comments or requests you may have:

Rep Referral ID:

(if applicable)

I have read and agree to the Terms and Conditions

Please have a Sales Representative contact me.

Please inform me via email of occasional product updates and sales specials.