Please fill out the form below.

We will email you the Illinois Shines Designee Registration Form to complete and send back to us. We look forward to helping you serve your customers!

First Name *

Last Name *

Cell Phone *

Email *

Company Name *

Company Phone Number

Address *

City *

State *

Zip Code *

Company Website

Any Additional Comments, Questions Or Special Requests?

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from DFK Sales Inc. Message frequency varies. Message & data rates may apply. Text HELP to (309) 444-6208 for assistance. You can reply STOP to unsubscribe at any time.