Cricket 2.0 Authorized Retailer Order Form

Order Requested By

First NameLast Name

Order Requester's Email

example@example.com

Purchase Order #

UID

Onsite Contact Name

First NameLast Name

Onsite Contact Number

Area CodePhone Number

Onsite Contact E-mail

PM Name

First NameLast Name

Office Number

Area CodePhone Number

Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Requested Delivery Date

Date must be 5 business days from submission. Freight will vary based on location & carrier lead times.

Lift gate / pallet jack needed? Required for delivered without loading dock.

Special Instructions

Please note if you have a preferred carrier

Order

Entryway Carpet: Ruffian II, Ebony Earth . Carpet Tile Size: 24" x 24",18 pieces / 8 SQ YD per carton / 72 Square Feet per carton. 10% overage will be added to ensure successful installation.

Entryway Carpet: Ruffian II, Ebony Earth $2.80

Carpet Tile Size: 24" x 24",18 pieces / 8 SQ YD per carton / 72 Square Feet per carton. 10% overage will be added to ensure successful installation.

Quantity / Square Feet Needed

Cricket 4mm LVT 483660, Color Stone $2.01

LVT Size: 12"x 24",11 pieces / 22 ft2 per carton, 10% overage will be added to ensure successful installation

Quantity / SF Needed

PSA-1 LVT Adhesive $44.56

1-Gallon Coverage -250 ft2 per container (over porous surfaces / spread rates will increase for non-porous surfaces, see installation guidelines)

Quantity / # of Pails

Style: M44578 CRICT Relay 14 Color: 001A-7. Carpet Tile Size: 24"x 24" 8 SY per carton / 72 Square Feet per carton. 10% overage will be added to ensure successful installation.

Style: M44578 CRICT Relay 14 Color: 001A-7$1.20

Carpet Tile Size: 24"x 24" 8 SY per carton / 72 Square Feet per carton. 10% overage will be added to ensure successful installation.

Quantity / Square Feet Needed

Infinity 2 Pressure Sensitive Carpet Tile Adhesive$106.61

4-Gallon Pail. Coverage - 900 ft2 per Container

Quantity / # of Pails

Wall Base: 4” TP CB, color Moonbeam$0.42

100 LF per carton

Quantity / LF Needed

MR-101 Cove Base Adhesive (Cartridge)$5.25

Coverage:Cartridge 4" - 50 LF

Quantity / PC Needed

3.2 MM Fusion Strips, color Moonbeam$4.14

12’ / PC, order will be rounded to the next full piece

Quantity / LF Needed

Fusion Strip Tape$24.64

164 LF per roll

Quantity / Roll Needed

Total $0.00

*Freight/special handling cost & taxes will be added based on location/warehouse.

Payment Method

If you do not have the wire payment information you may download it below.

Cricket Wireless AR Order Form

Order *

Order