Store Fixtures Supply
Order Toll Free: 866.421.0961
Toll Free Fax: 866.740.0147

Please print, complete and return this form to us via fax.

QTY      SLATWALL FINISH	QTY      SLATWALL FINISH
_______ White Melamine	_______ Mahogany Melamine
_______ Standard Gray Melamine	_______ Cherry Blossom (New)
_______ Dove Gray Melamine	_______ Pearwood Melamine
_______ Almond Melamine	_______ Brushed Aluminum Melamine
_______ Black Melamine	_______ Unfinished Paint Grade
_______ Hardrock Maple Melamine	_______ Acrylic Mirror
_______ Oak Melamine	_______ Maple Veneer
_______ Soumi Birch Melamine	_______ Red Oak Veneer

SHIP TO:

Your Name: ______________________________________________________

Company Name:__________________________________________________

Shipping Address:________________________________________________

City:___________________________ State:_________ Zip Code:__________

Phone:_________________Fax:_________________ Email:_______________

$3.00 Charge per slatwall sample + $7.00 UPS sample shipment delivery charge.
- Most sample orders are shipped within 1 business day.

PAYMENT INFORMATION:

DISC     VISA     MC

#__________________________________________ Exp:_______/________

C/C Billing Address:_____________________________________________

Zip Code:___________________________ Security Code:______________

Approval Signature:________________________________________________

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