Name

Company

Address

City

State

Zip

E-mail Address *

Phone

Architect or Designer's Name *

Architect City *

Project Name / City / or Sidemark *

Choose flooring product and sample size in the drop down menu.
If custom size is desired, please note that in the description box below.

Quantity *

Sample ID# / Description / Company / Folder Description *

Shipping Requirements:
We take pride in fulfilling your sample needs and making sure they arrive on time. Please indicate
below when these samples need to be on your desk, and our staff will guarantee their arrival!
* This information is required to assure your sample request arrives on time.

Date *

Select One:

Morning

Afternoon

Flooring Product *

For your convenience, this sample order form will accommodate all Shannon Sales flooring products. Please use the drop-down menu to the right of each description line to select product line.