Sample  
*Product Name:                      *Description (size/color):
 
Sample 2
*Product Name:                      *Description (size/color):
 
Sample  
*Product Name:                      *Description (size/color):
 
 

*Full Name:

*E-mail:

Company:

*Address 1:

Address 2:

*City, *State, *Zip:
-- AK AL AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA SC SD TN TX UT VA VT WA WI WV WY
*Phone:

Fax:

Shipping Information

There is no charge for a sample if you supply us with your  Federal Express or UPS account number. We can also send the sample using our priority shipping for a charge of $10 which will be deducted when you place an order.

*Your Shipping Account #  (type K-READ if we are using our account and billing to your credit card number below.)
UPS Fedex
Priority Requested:
Standard (Ground) Rush (Air)

Credit Card Payment: Type
Credit Card Number:
Exp. Date:
Name on Card:

Due Date:

Additional Comments:

Note: You will be notified in advance if we have to charge an additional fee for high value samples.