FILM SAMPLE ORDER

Rep Name*

Rep Company*

Rep Email*

Rep Phone*

Today's Date*

Date Sample Needed*

Item*

Structure*

Select which perforation is needed*
Not NeededLaserHot PinOther

Perforation if Other

Quantity of Rolls*

Width (Inches)*

Length (Feet)*

Price Per Roll*

Is the customer flexible with material type/width or length? If so, please included details in this section. If no details needed, please write "NA".

Notes or Details*

Shipping Company Name*

Shipping Contact Name*

Shipping Contact Phone Number*

Please include address, state, and zip code.

Shipping Contact Address*

Freight Responsibility*
Preferred PackagingCustomer

Shipping Method*
Ground2nd Day AirNext Day Air MorningNext Day Air Afternoon

Customer Shipping Account Number (If Applicable)

Please leave this field empty.