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Project Sample Request Form:

*Required Items

Please send loose samples to: BrickImaging Inc Attn: Lab Samples 1631 E Lincoln Ave Fort Collins, CO 80524


    Contact Information
*Name
  
Company
  
Address
  
City
  
State
  
Zip
  
Phone [cell, home, office, other]
  
Fax
 
*Email
  


    Project Information
*Project Name
  
Address
  
City
  
State
  
Zip
  
  I will be sending loose brick to be stained (please print and mail this form with your sample)
  I am requesting a standard (check) brick/ block/stone sample packet. (allow multiple selections)


    Comments
 

Notes:
If sending loose samples, please write the Sample Request ID on the package. Standard samples should be received within 7-10 business days after receipt. Customized samples should be received within 10-14 business days after receipt.

    Attach Files
   
   


           

 

  
Thank you very much for your interest in our services. We wil respond to your request within 48 hours.
 
 

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