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Patrice

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MarkNet Group, Inc.

Showroom Application

To finish the applications process, press the "submit" button at the bottom of application.

Applicant Information

Prefix:	Mr. Mrs. Ms.
First Name *:
Last Name *:
Middle Name (full - not initial):
E-mail * :
Address (Do not use P.O. Box):

City:
State:
Zip:
Daytime Telephone No:	(include area code)
Nighttime Telephone No:	(include area code)
Mobile Telephone No:	(include area code)

Company Information

Full Company Name:
Address:

City:
State:
Zip:

Mailing Address (if diferent from above):

City:
State:
Zip:

Telephone No:	(include area code)
Fax No:	(include area code)
Company Website:

Collection Information

(Check all categories that are applicable)

Men's Wear:	Suits Denim Shirts Sportswear Special Occasion/Formal Designer

Women's Wear:	Dresses Sportswear Denim Special Occasion Designer

Juniors:	Denim Knitwear Tops

Young Men's:	Denim Pant Shirts

Accounts Served * :	Specialty Boutiques Mail Order Catalogs Specialty Chains E-commerce Department Stores Museum Stores Gift Stores Hotels/Resorts Other:

Please type in the code from the image * :

(All Fields with are required)*