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Account Application
Account Application
To establish a client account with Diane James Designs, please complete and submit this application. You will be notified by email when your account has been activated.
Retail Store:
Yes
No
Business Type:
Contact First Name:
Contact Last Name:
Contact Job Title:
Company Name:
Address:
 
City:
Province:
U.S. State/Canadian Prov. Code:
 Postal/Zip Code:
Country:
Phone:
Fax:
Resale #:
Web Site URL:
E-mail Address:

Create Password:

Confirm Password:

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112 Main Street, Norwalk, Connecticut 06851
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