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Order Sample

Registered ASI, PPAI, and SAGE distrubutors can fill out the sample order form below to place a sample order. Samples are billed at EQP NET plus shipping, standard shipping is UPS-Ground. If expedited shipping or other shipping method is required, please specify in the "Shipping Method" section.  For additional questions or requests, please contact ATTEFF customer service.

Bill To Address:
Bill To Company:  
Contact: First Name: Last Name:   
Address Line1:  
Address Line2:
Bill To City:   State:     Zip:        
ASI/PPAI/SAGE #:    
Phone #:   Fax #:  
Email:  
Ship To Address:
Ship To Company:  
Contact: First Name: Last Name:    
Address Line1:  
Address Line2:
Ship To City:   State:     Zip:        
Receiver Phone # (required by UPS and FedEx for expedided shipping):
Order Detail:
Item Number, Color, and Quantity:  
Blank or Random Sample:  (Random sample is not always available, we will ship blank if no random sample is available.)
Shipping Method:  
Freight Charges:  Account #:   
Additional Instructions:
      
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