Dealer Sample Request - Robbins Sports Surfaces

Dealer*

Company Name (if different from dealer):

Your Name:*

First Last

Email*

Ship to Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Name of Product Requested (check all that apply):*

Qty Requested of Air-Channel Classic Samples:*

Qty Requested of Air-Channel Star Samples:*

Qty Requested of All Star Portable Samples:*

Qty Requested of Bio-Channel Classic Samples:*

Qty Requested of Bio-Channel Star Samples:*

Qty Requested of Bio-Channel SB Samples:*

Qty Requested of Bio-Channel LP Samples:*

Qty Requested of Bio-Cushion Classic Samples:*

Qty Requested of Eclipse Samples:*

Qty Requested of Eclipse SB Samples:*

Qty Requested of MVP Samples:*

Qty Requested of Sportwood Samples:*

Qty Requested of DanzAire Samples:*

Qty Requested of Elan Basketweave Samples:*

Qty Requested of Le Lena A Samples:*

Qty Requested of Le Lena B Samples:*

Qty Requested of Pro Tap Samples:*

Qty Requested of Galaxy Fit Samples:*

Qty Requested of Galaxy Ultra Samples:*

Qty Requested of Galaxy Classic Samples:*

Qty Requested of Galaxy Mat Samples:*

Qty Requested of Galaxy XTreme Samples:*

Qty Requested of Pulastic Classic Samples:*

Qty Requested of Pulastic Pro Samples:*

Qty Requested of Pulastic GT 100 Samples:*

Qty Requested of StrataSport Samples:*

Qty Requested of Durathon Samples:*

Qty Requested of Combi Floor Samples:*

Qty Requested of "Other" Floor Samples:*

Please describe in detail the product sample(s) you are requesting:*

Are these samples for a specific project(s)?*

Yes
No

If Yes, please list the names of the project(s):

Do you need literature as well?*

Yes
No

If yes, please list the literature you need and the quantity you are requesting:

*Note: All samples and literature will be shipped via UPS Ground within 2-3 business days. If you need expedited shipping, please include your UPS or FedEx account number in the box below and the desired shipping method (i.e. Overnight, 2nd Day, etc...). Sample and literature requests received after Noon (ET) will be processed the next day.*

I agree to the shipping policy.

Do you need expedited shipping per the note above?*

Yes
No

If yes, please provide your UPS or FedEx account number in the field below:*

Comments/Special Instructions:

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Email

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Sample & Literature Request robbinsfloor.com