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FLOOR COVERING REPLACEMENT: ORDER FORM

* Indicates required field

Customer (Bill To) *

Shorthand or abbreviated customer name can be used in this field for customers with ongoing accounts

Purchaser's name / Authorized by *

Fill in as follows: Name of person filling out this form / Name of manager, supervisor or authorized purchaser who authorized this order (if same, enter one name only)

Purchase Order # (if required for invoice) *

If no purchase order number is provided, the purchaser's name or "Authorized By" name will be used as a purchase order # on the invoice. Note: If a PO is required for the invoice, work may not proceed until it is received, so please provide upon initial placement of order

Job Site Address (Include suite # if applicable) *

eg. 101-999 Main

Floor Covering Type (1) *

Floor Covering Type 1- Rooms: *

Throughout/ Complete Unit Living Room Dining Room Hallway Bedroom 1 Bedroom 2 Bedroom 3 Kitchen Bathroom(s) Storage Room(s) Stairs Entrance Other (please specify in comments)

Floor Covering Type (2) *

Floor Covering Type 2 - Rooms: *

Living Room Dining Room Hallway Bedroom 1 Bedroom 2 Bedroom 3 Kitchen Bathroom(s) Storage room(s) Stairs Entrance Other (please specify in comments)

Floor Covering Type (3) *

Floor Covering Type 3 Rooms (please list): *

Status *

MOVE OUT DATE *

If applicable (eg. if unit is currently occupied, but will become vacant prior to flooring replacement)

MOVE IN DATE *

If applicable: (unit is vacant or vacating with a new subsequent move-in scheduled). Use Month + day format, ie. March 1. If not rented, you may enter an available date in this field (ie. "Available March 1" or "Available ASAP")

Site Contact Person(s) *

On site resident manager, caretaker or maintenance person who will be available to provide access for measurements if necessary and installation

Site Phone Number(s) *

Comments/Entry instructions,etc. *

Please specify product colours, styles,etc. (if applicable). Provide any other additional details that may be helpful to us to process your request efficiently. Examples: Scheduling notes (specifically relating to deadlines, other contractors' schedules, etc); Entry codes/instructions; Access dates/times; Work specifics not covered in order fields above

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FLOOR COVERING REPLACEMENT: ORDER FORM

www.celebrityflooring.comCelebrity Flooring Ltd.779 Erin St. Winnipeg, MB R3G2W2 204-788-0015

www.celebrityflooring.com
Celebrity Flooring Ltd.
779 Erin St.
Winnipeg, MB R3G2W2
204-788-0015