Sample Request and Order Page

Niagara	Puzzle Floor Classic	Denali

Complete the form below to:

• Order your free sample kit, containing two full size pieces of your preferred model and color swatches  

Or to:

• Place an order

We will be in touch with you within 24 hours to confirm your request and finalize payment by credit card.

Note: Sample kits are free, though we do charge for shipping and handling in North America. Shipping and handling is $20.00. Should you order a sample kit and than buy a Puzzle Floor, we will refund the $20.

We are in the process of installing and testing our online shopping cart and expect it to be ready shortly. In the meantime, you can proceed with your request by filling in the following information and pressing submit.

Date

Sample Request

Order

Delivery Date   Square feet

Model Niagara Denali Puzzle Floor Classic

Color

Complementary Color   Want a second color? Select your   preference here.

Name*

Office Phone

Home Phone*

Email*

Confirm Email*

Address*

Address

City*

State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Province* Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Zip/Postal Code*

Business Name

Business I.R.S or S.S.N (required for customs clearance on US bound freight)

Will someone be at address to receive shipment? Yes No

Will the delivery need to be scheduled, when someone is at home? Yes No

Best day and time to call (include your time zone)

Special Notes

We will contact you for confirmation of the order and arranging payment by credit card. Press submit or print this page and fax to (506) 356-8101.