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Catalog & Sample Request Form

Sample requests must be received by 3pm PST to ship same day. Samples are billed at EQP Pricing plus freight and are not returnable. Samples totaling $5.00(R) or under will be sent at no charge if a SHIPPER ACCOUNT # is provided.

*required fields

 
Your Information
 
*Contact Name
*Company Name
ASI/SAGE/PPAI #
Purchase Order #
*Street Address
Street Address 2
*City
*State
*Zip Postal
Country
*Phone
Fax
*Email Address
 

Ship To Information

If same as above

*Contact Name
*Company Name
*Street Address
Street Address 2
*City
*State
*Zip Postal
Country
*Ship Via UPS Ground  UPS 3 Day  UPS 2 Day  UPS Next Day 

FedEx Ground  FedEx 3 Day  FedEx 2 Day  FedEx Standard Overnight

Shipper Account #
 

Sample Item #(s)

Please specify quantity of each sample required

Item # :  Quantity :  Color :
Item # :  Quantity :  Color :
Item # :  Quantity :  Color :
 
Comment :
Catalog needed Yes  No
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