SRC Display & Sample Order Form

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Customer Service 800-452-4474
Hours 8:30 am - 6 pm Est
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SRC Display & Sample Order Form
Account #
New Account?*

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Enter Account # Here*
This account is not listed, please fill out the rest of the form manually
Company*
Bill To Address*
City*
State*
Postal/Zip Code*
Is Billing Same As Shipping?*

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Ship To Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is there a Loading Bay at the ship-to location?*

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*Important - Related To You Email*
Please select the type of rep (Hard, Soft or "Full Line") and a dropdown will appear to select your email address.

The email in the "Rep Email" field, will be sent all order updates related to this submission.
Type of Rep*

Hard SurfaceSoft Surface"Full Line"
SS Rep Email List*
HS Rep List*
Rep Email*
Rep*
Dealer Email*
Purchase Order #*
Given By: *
Side Mark*
Taken By: *
Selection Section

Please Click The Arrow To The Right Of The Section To View Available Choices

SRC Display Packages	US	CAD
Stanton Rug Company Display & Samples	$999	$1,350

Flex Packages	US	CAD
Flex Collection I & II (2 hand boards (12 sku’s)	$49	$65

Tile & Stone Packages	US	CAD
Mosaic Tower w/ 30 samples boards	$629	$850
24”x48” Large Format Porcelain Tile Wing Display (includes 20 sample boards)	$529	$715
12”x24” Porcelain Tile Tower display only	$469	$635
12”x24” Porcelain Tile Tower display w/ 56 tiles	$649	$875

Style	Color	Size
Table Top Glass Mosaic Display/Tile	N/A	N/A
Recycled Glass Display Rack	N/A	N/A
Recycled Glass Mosaic Set	N/A	N/A
Maiolica 3X6	White	3x6
Maiolica 3X6	Tender Grey	3x6
Maiolica 3X6	Biscuit	3x6
Maiolica 4X10	White	4x10
Maiolica 4X10	Tendery Grey	4x10
Maiolica 4X10	Biscuit	4x10
Marrakesh 6X6	Blue	6X6
Marrakesh 6X6	Dark	6X6
Marrakesh 6X6	Green	6X6
Marrakesh 6X6	Off White	6X6
Marrakesh 6X6	Terra Cotto	6X6