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Date request made: ________________Date samples needed by: ________________
Project
Designation (for your reference): _______________________________________
Your
name: ______________________________________________________________
Company
name: __________________________________________________________
Address:
________________________________________________________________
City,
State, Zip: __________________________________________________________
Phone:
_________________ Fax: ____________________________
E-mail:
__________________ Web site: _______________________
Please
send the following Viela samples:
Types
of finishes:
One
color Finishes:
Color
#____________________________
(Note: This results in a single color sample. Reference paint chip
# and name of national manufacturer).
Multiple
color Finishes:
Color 1 #____________________________ % of sample seen in this color
Color 2 #____________________________ % of sample seen in this color
Color 3 #____________________________ % of sample seen in this color
(Note:
This results in a multiple color sample. % need to add to 100%.
Reference paint chip # and name of national manufacturer).
Options:
Wax
finish _________No (Yes is the default) Buff finish __________No
(Yes is the default)
Sample
Match:
Enclose
a sample created by another party and we will replicate as close
as possible.
Special
Requests: __________________________________________________________________________
__________________________________________________________________________________________
If
you have any questions, please call us at 1-800-776-3316 or 305-576-3316.
Fax this form to us at 305-576-8416.
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