SAMPLE REQUEST: Contact Information

Please provide us with your contact information:

* First Name

* Last Name

* Street Address

* City

Address Line 2

* State

* Zip Code

* Phone Number

* Email Address

* Occupation:

* Have you purchased from us before?

YES

NO

SAMPLE REQUEST: Material Information

Samples are reserved for individuals within the industry. Due to the fact that there are no two stones exactly alike, we ask that you respect the fact that samples are a reference point only. As accurate as a sample might be, there may always be slight variations in color, texture and size.

* Name of Material

* Preferred Size:

Name of Material

Preferred Size:

Name of Material

Preferred Size:

SAMPLE REQUEST: Shipping Information

* Would you like the sample(s) shipped to the address listed in the Contact Information section?

YES

NO

If you answered NO to the previous question, please provide us with the address you would like to have the sample(s) shipped to:

First Name

Last Name

Street Address

City

Address Line 2

State

Zip Code

SAMPLE REQUEST: Billing Information

We are happy to provide our clients and potential clients with FREE samples, we only ask that you pay for the shipping costs. Our staff will call you before sending out any samples to confirm all orders and verify shipping and billing information.

I already have an account, please use my:

My account number is:

I do not have an account number: Please charge my card for shipping costs.

Name on Card

Credit Card Type

Credit Card Number

CVV Number:

Expiration Date (mm/yy)

Billing Address: (if different from Contact Information)

State

Zip Code

THANK YOU!

* Indicates Response Required