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New Customers
Please complete this form below, and when you are finished, click the Submit button.

Some one from Corporate Amenities will be in contact with you shortly to give you information about our pricing and terms. Please note that submission is only a request for information. A confirmation of services will be sent to you after both parties agree in writing to conditions set forth

Fields marked with a * are required.

Type of Client*: 
(If you are renting housewares or furniture for 
personal use, please select "Individual") 
Please enter the type of client:
Name of Company or Apartment Community*: 
(If you selected "Individual" on the previous question, 
please enter "Individual" again) 
Name of Contact*: 
E-Mail Address*: 
Confirm E-Mail Address*: 
Telephone Number*: 
Extension: 
Fax Number: 
Mailing Address*: 
City*: 
State*: 
Zip*: 
How will you be paying?*: 
Date of Delivery*: 
(Weekdays only please) 
Property You Would Like Us to Deliver To*: 
(This may be the name of an apartment community, 
"house,"or a description of another location) 
Phase: 
Apartment Number: 
(You may leave this blank if this 
is not an apartment community) 

Property Address
(You may enter only the city and state unless the location is not an apartment community) 
Street: 
City*: 
State*: 
Zip: 
Length of Lease*: 
What is the length of this lease:
How many bedrooms need furniture and/or housewares*: 
How many bathrooms need housewares*: 
What kind of furniture would you like in your package*: 
(All packages with furniture include a 25" TV and pictures) 
Please let us know which customized furniture package you are requesting
What kind of housewares would you like in your package*: 
Please let us know which customized housewares package you are requesting
What bed sizes would you like in each bedroom:   
Master*: 
Other requests for the master bedroom
2nd: 
Other requests for the 2nd bedroom
3rd: 
Other requests for the 3rd bedroom
4th: 
Other requests for the 4th bedroom

If you are requesting a new delivery and would like Upgrades or if this is an existing order and you are requesting Add-Ons, please check what you would like below.
DVD Player
    19 Inch Color TV
    25 Inch Color TV
    32 Inch LCD TV
    Cordless Phone with Answering Machine
    Boombox/CD Player
    Desktop Stereo
    Iron
    Ironing Board (if you are not ordering a housewares package)
    Vacuum Cleaner (if you are not ordering a housewares package)
    Broom, Dust Pan, and Mop (if you are not ordering a housewares package)
    Blow Dryer
    Crib with Mattress and Linens
    High Chair
    Changing Table
    Microwave
    Rice Cooker
    Wok
    Blender
    Desk, Chair, and Lamp
    Bar Stools
    Patio Set (table and four chairs)
    Roll-Away Bed
    Roll-Away Linens
    Sleeper Sofa Linens
    Pictures (if you are not ordering a furniture package)
    Ficus Tree
    Washer and Dryer
    Welcome Basket
      Other
 
Would you like housekeeping*:
Is there anything else you’d like us to know about your request?
Is there anything else you’d like us to know about yourself and/or your company or apartment community?
Do you have any questions?
(Please note that we will automatically e-mail you with pricing once we receive your request)
How did you find out about Corporate Amenities?*


14059 Proton Road - Dallas, TX 75244 - Tel: (800) 894-9686 / (972) 361-0633 - Fax: (972) 361-0634 - EMAIL US

© 2008 Corporate Amenities