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Samples Request Form

PLEASE NOTE: WE ARE ONLY AUTHORIZED TO SERVICE CUSTOMERS IN NORTHERN CALIFORNIA AND NORTHERN NEVADA.  IF YOU ARE OUTSIDE OF THESE AREAS, PLEASE GO TO OUR LINE CARD PAGE AND CONTACT OUR MANUFACTURER'S WEB SITE FOR YOUR LOCAL REPRESENTATIVE.  WE CANNOT RESPOND TO INQUIRIES OUTSIDE OF OUR AREA.

Simply fill in the following information to request a sample from our manufacturers.  Sample requests will be qualified and only shipped to valid OEM customers.

* Required Fields
* NAME
* COMPANY
* ADDRESS
* CITY
* STATE
* ZIP CODE
COUNTRY
* PHONE
* E-MAIL

SELECT MANUFACTURER


REQUEST SPECIFIC PRODUCTS
(use part# if known)


* ESTIMATED ANNUAL
PRODUCTION VOLUME

BRIEF DESCRIPTION OF DESIGN APPLICATION
DELIVERY METHOD REQUESTED US MAIL
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