Order Form
Company Name:
Contact Person:
P.O. #:
Order Date:
Date Requested:
Bill to:
Company Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Ship to:
Company Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Quantity of Shower Bases Ordered:
Shower Base Color:
Please Check All That Apply:
Single Threshold
Double Threshold
Neo-Angle
Cove All Sides
Please provide a drawing, including drain location dimensions - via fax or mail to complete this order.