Ultraflexx Request Sample Form

Sample Request Form

*EFFECTIVE JANUARY 2008- REQUESTOR WILL BE RESPONSIBLE FOR ALL FREIGHT CHARGES. SAMPLE MATERIALS ARE FREE OF CHARGE.

Please fill in the form below to complete your request
All areas with a * must be filled in.

Product information/swatches:

Specify quantity of each:

Full PVC Product line (excluding textiles) 4" x 6" swatch book

Full Textile Product line 4" x 6" swatch book

Full Product line 10" x 12" Hard Cover Binder with spec sheets & swatches (Binder is subject to a $35 dollar charge)

Wallscapes 3.5" x 8" swatch book

BIOflex- (Biodegradable PVC) literature packet with swatch

Ultra Carpet Extra (UV & solvent)

Printed hand sample

Unprinted hand sample

Check out our new products!
Normandy Lite (11oz. version of Normandy Pro 13oz.)
	Printed hand sample

	Unprinted hand sample

	Sample roll

Strip Mesh Plus (8 oz mesh with PVC backer)
	Printed hand sample

	Unprinted hand sample

	Sample roll

UltraMesh Plus (8 oz mesh, same as Strip Mesh Plus but without backer)
	Printed hand sample

	Unprinted hand sample

	Sample roll

UltraCotton C370 (11 oz %100 natural cotton with a heavy canvas texture)
	Printed hand sample

	Unprinted hand sample

	Sample roll

Please specify other samples needed and their quantities, such as printed or unprinted hand samples of a specific product or sample rolls (for test-printing) of a specific product. Sample rolls are typically 30" x 25'. For sample rolls, please specify matte or gloss finish where applicable. *Ultraflex materials are not for Aqueous printers.

Requestor details:

*Your Company:

*Your First Name:

*Your Last Name:

*Phone#:

ext.

Fax#:

*Email Address:

Web Address:

Shipping Details (we can ship direct to you or your customer):

*Attention
(receiver's name):

*Receiving Company Name:

*Company Address:

*City: *State: *Zip:

*Phone#:

ext.

Fax#:

*Email Address:

Web Address:

*Printer(s) your Customer/receiving company has (specify Name and Model):

-We will process and ship your request within 24 hours. If you are not contacted, your request will ship to the address provided. ** larger quantities will be considered upon special request **

Please select a shipment destination and a carrier:

(note- choose a carrier for which you can provide an account #):

This is my account number

This is my Customer’s account number

Thank you! For help with samples please call the Marketing Department at (973) 627-8608 ext. 119