REQUEST FOR SAMPLE PICK- UP

Name of Institution (required)
Hours of business

Contact Person (required)
Sales Representative

Street Address (required)
Is the sample boxed and ready now? Yes No

City (required)
State(required)

If not, when will it be ready?

zip Code (required)
phone (required)
Special Instructions:
Sample(s) to return:

Qty.		 Pew

Qty.		 Chair

Qty.		 Other misc. item

You can expect the sample to be picked up within 1-2 business days from when you submit the request. If you have any questions, please contact:

Religious Sales Dept.
Sauder Manufacturing Company
800-537-1530
sales@sauderworship.com