Exclusive Dealer / Installer Order Form
2 week lead time is needed for all standard orders. 3 week lead time is needed for all custom orders.
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C&S: Black ($2.00/lb)
C&S must be ordered in 1 ton increments.
$
4,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
C&S: Sandy ($2.25/lb)
C&S must be ordered in 1 ton increments.
$
4,500.00
Quantity
1
2
3
4
5
6
7
8
9
10
C&S: Canyon ($2.25/lb)
C&S must be ordered in 1 ton increments.
$
4,500.00
Quantity
1
2
3
4
5
6
7
8
9
10
C&S: Stormy ($2.25/lb)
C&S must be ordered in 1 ton increments.
$
4,500.00
Quantity
1
2
3
4
5
6
7
8
9
10
C&S: Rye ($3.00/lb)
C&S must be ordered in 1 ton increments.
$
6,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
C&S: Sky Blue ($3.00/lb)
C&S must be ordered in 1 ton increments.
$
6,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
C&S: Cloudy ($3.00/lb)
C&S must be ordered in 1 ton increments.
$
6,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
C&S: Custom Blend Using Above Colors ($3.50/lb)
Custom C&S must be ordered in 1 ton increments. Please indicate the custom blend needed in the text box at the bottom of this order form.
$
7,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
C&S: Custom Color (not color listed above) (REQUEST PRICING)
Custom C&S colors can be requested and must be quoted for pricing.
$
Free
A/B Primer Kit
1.5 gallon kit
$
120.00
Quantity
1
2
3
4
5
6
7
8
9
10
Superduty Kit
1.5 gallon kit
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Ground Rubber & Colorant Kit
$
32.00
Quantity
1
2
3
4
5
6
7
8
9
10
Accelerated Binder- 55 gallon drum
Polylast standard binder
$
1,582.50
Quantity
1
2
3
4
5
6
7
8
9
10
Accelerated Binder- 42lb pail
Polylast standard binder
$
147.00
Quantity
1
2
3
4
5
6
7
8
9
10
Alphatic Binder- 42lb pail
UV blocking binder
$
315.00
Quantity
1
2
3
4
5
6
7
8
9
10
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Delivery Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Special Instructions
Date
*
-
Month
-
Day
Year
Date
Signature
*
By signing, I confirm that I have reviewed and verified the accuracy of my order details, including item specifications, quantities, and prices. I acknowledge that once this order is placed, it is non-refundable and may not be modified. I accept full responsibility for any errors or omissions in the order details as submitted.
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