Requested Samples

**Note: Please include quantity and desired finish you wish to receive. If you wish for samples to be stained with stains, dyes, acid-staining, etc, please include the Distributor and colour code/name. Some samples may be subject to a fee under certain circumstances.

Sample Request Form

Date: *

( Date format mm-dd-yyyy )

As per our meeting, should you require for samples to be made, ordered for your library or borrowed please fill out this form. Please advise me of any queries you have regarding availability of options. If samples are time-sensitive please let me know as soon as possible seeing that options may be limited and could take some time to be arranged and ready upon your request.

Company: *

Address: *

Contact Person(s): *

Phone Number: *

Email Address: *

Date to Receive Samples By: *

( Date format mm-dd-yyyy )

Polished Concrete

Light cut polished concrete sample

Medium cut polished concrete sample

Deep cut polished concrete sample

Stained (Optional)

Terrazzo

Please refer to www.stoneedgesurfaces.com under Sample Gallery to Terrazzo Flooring Gallery

Specify Mix:

Specify Matrix:

Custom Terrazzo

Specify Aggregates:

Specify Matrix:

Urethane Coatings

Specifics:

Other(s)

Specifics:

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