Syndesis Sample Request

Sample Request Form

Recipient Information

Name:

Project:

Firm:

Address:

City:

State:

Zip Code:

Phone (required):

Fax:

Email (required):

This is a residential address

Samples
Syndecrete Standard Color Sample Box - $ 10 per box Contains 11 standard colors Click to see the colors. Syndecrete Custom Color Sample Box - $ 15 per box Contains a small assortment from our library of hundreds of mix designs Click to see some examples. A single Syndecrete Sample chip at no cost Please specify preferred color/finish: Custom Orders Available: Syndecrete can provide colors and aggregates to unique specifications. Custom samples are available. Please contact Syndecrete for pricing or to submit a sample to Syndecrete for color matching.

Order

For samples box orders, we have 3 payment options:

Option 1: Prepay
I will prepay my order

Please note: Syndecrete does not accept credit cards and must receive payment before sending sample boxes. Please send a check made out to Syndecrete.

Payment Total:

If you provide an authorization to use your FedEx or UPS account to ship the samples, as a courtesy, we will not charge you for the sample box(es). Note that the shipping weight for one sample box is 2 lbs and 3 lbs for two boxes. Be aware than UPS and FedEx will not ship to a P.O. Box address.

Billing information is the same as recipient information above.

If not, please fill in the following information:

Billing Name:

Billing Address:

Billing City:

Billing State:

Billing Zip Code:

Billing Phone:

Option 2: UPS

Shipping Account #:

Preferred shipping method:

Estimate shipping cost and time at the UPS Website

Option 3: FedEx

Shipping Account #:

Preferred shipping method:

Estimate shipping cost and time at the FedEx Website

Additional Information

Please allow 1 business day to process your request.

Review all your entries before submitting.
Thank you for your request.