PALECEK | Catalog Request Form


Palecek believes that consumers are best served by their local designer or retailer. Our principal interest is in conducting business with designers who seek out Palecek’s signature natural elegance for their projects and clients, as well as servicing qualified dealers who will stock, display, and promote Palecek products in		store locations in their market area. In order to maintain our distinction within the industry, Palecek provides catalogs TO THE TRADE ONLY. Please provide the information on the listed below on the catalog order form. Make sure to refer to the check-off list before mailing in the form with your payment.

GENERAL INFO (* Indicates Required Field)

FIRST NAME *

LAST NAME *

JOB TITLE

COMPANY NAME *

WEBSITE

STREET ADDRESS *

CITY *

STATE *

ZIP *

PHONE*

EXT

FAX

EMAIL *

ADDITIONAL INFORMATION

Company Resale Number	Palecek Customer Number


	How did you hear about Palecek?
	Sales Rep Showroom Designer Email Advertisment Magazine Word of Mouth Other:

ORDER

Select From Current Catalogs

PALECEK Furniture Vol.21 (2011/2012) only	$40.00
PALECEK Accessories & Lighting Vol.39 (2011/2012) only	$20.00
Both PALECEK Furniture and Accessories & Lighting Catalogs	$50.00
PierceMartin Catalog (2012) only	$60.00 *NO CHARGE to those who qualify (Designers Only)
All PALECEK & PierceMartin Catalogs	$50.00 or $110.00 (Depending on qualification)

Send Check and Completed Form to:

   PALECEK
   Attn: Catalog Orders
   601 Parr Boulevard
   Richmond, CA 94801

REMINDER!

	Complete all contect information.
	Provide a mailing adress and email.
	Clearly indicate which catalog(s) you'd like to purchase.
	Enclose a check for payment with your form.