Become a Retailer

Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Extension
Company Name*
Company Website*

If you do not have a website, please put “NA.”
For the questions below: Only answer YES if this is a requirement or your application could be denied automatically.

Please Note: If you answer NO to all questions, your application will be denied.
Do you have a showroom?*
- Yes
- No
Has your company done business with UltraComfort in the past?*
- Yes
- No
Are you a furniture store?*
- Yes
- No
Are you exclusively online internet dealer?*
(No physical storefront)
- Yes
- No
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.