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Carpet Order Form
 

CARPET INFORMATION

Carpet Manufacturer:
Product Name:
Product #:
Color Name:
Color #:
Broadloom (12' Width)
Length of Roll Required:
Total Sq. Yds. Required:
Lees Wet Set Adhesive
for Unibond Backed Carpet
(4 gal. pail = approx. 32 sq yds)
# of pails required for project:
Carpet Tile:
Carpet Tile Sq. Yds Required:
Lees Pressure Sensitive Adhesive
for Thermobond Backed 6' wide
products and 18" x 18" Carpet Tiles.
(5 gal. pail = approx. 225 sq. yds)
# of pails required for project:
 

BILLING INFO:

* Customer Purchase Order#:
* Customer Name:
Address #1:
Address #2:
City:
State:
Zip Code:
Phone #:
Fax #:
* Email Address:
 

 

SHIPPING INFO:
Shipping Address Name:
c/o Shipping Address Name:
Sidemark:
Street Address:
City:
State:
Zip:
Phone #:
Fax#:
 

 

Freight Carrier Desired:
 

Prepay and Add Freight to Invoice:

YES    NO
Freight Collect: YES   NO
State Sales Tax Exemption Certificate: YES   NO
* required fields- need to be filled out before you submit