FILM SAMPLE ORDER

Please fill out the following fields to order film samples.

Rep Name *

First

Last

Rep Email *

Rep Phone Number *

Today's Date *

Date Sample Needed *

Item *

Structure *

Perforation *

Perforation (If Other)

If you selected the "other option" above, please explain.

Quantity of Rolls *

Width (Inches) *

Length (Feet) *

300’ Standard Length

Price Per Roll *

Notes or Details *

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".

Shipping Contact Name *

Shipping Contact Phone Number *

Shipping Contact Address *

Please include address, state, and zip code.

Freight Responsibility *

Shipping Method *

Customer Shipping Account Number (If Applicable)