Sample Request Form

Please state the color and size of the material that you are interested in. There will be no charge for the samples, only for the shipping costs. 

Please enter your UPS or FedEx account number. If you do not have an account number please enter a credit card number with which UPS can directly bill you.
Name: *
Address: *
Apt/ Suite No.:
City: *
State: *
Zip Code: * (5 digits)
Daytime Phone: *
Email: *
Method of Payment:
Account Number: *
Expiration Date:
CID # (3 digits on back of card/ 4 digits if using AMEX):
Credit Card Billing Address (If Different From Shipping Address)
Material Needed:
Quantity:
Date Needed By:
Questions/ Comments:

 

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