Designer On Call Application

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Miromar Design Center

Please complete and submit this electronic application. We will review within 10 business days and notify you about the next step in the process.

    Contact Information

    *FL State License #:

    Tax Exempt #:

    YesNo

    If yes, what type of insurance?


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    If other affiliations, please specify below.

    *Are you a full time resident in Southwest Florida?

    If not, what months are you here? Hold down the CTRL key to select multiple values.

    About You

    Specializing in What Type of Design Projects?

    % Residential:

    % Commercial:

    Years of Experience:

    Education Background/College Major:



    Initial Consultation Fee Structure:

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    If other, please specify below.

    Please list Miromar Design Center Showrooms you frequently purchase from:

    *How did you hear about the DOC Program?

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    * Design consultations are independent contractors who calculates their fees and expenses based on individual job requirements and client needs. Miromar Design Center is not responsible for setting or enforcing the contractual terms or agreements established with private design consultations.

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