Delivery Form

SHIPPING TO CONNECTICUT ADDRESSES ONLY
The cost per sample swatch is $5.00 each, sales tax will be added.

First Name*

Last Name*

Email*

Number of Samples*

Items Ordered*

Preferred Showroom Location*

Delivery Address*

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Address 1:

City:

Country:

State/Province:

Postal Code:

Street address, City, State, Zip code

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Street Address

City / Town

State

Zip Code

Phone Number* - -

Sales Tax Amount (for CT Residents)

Amount$0.00

Payment Method:*

Payment Notes/Additional Info:

Name Associated with Payment:*

Email Associated with Payment:*

Credit or debit card*