Sample Request Form

SAMPLE REQUEST FORM

Please fill out the required details. This form will be sent to the Rimex Metals Marketing Department for processing.

Please note that it may take up to a week to receive your samples. If required sooner, please advise the latest required date in the "Required Date" field.

Supply of samples is subject to sample availability. Rimex Metals will contact you if we cannot supply your required samples.

You can order up to 4 different samples using this form. If you required more than 4, please enter the details of the additional samples you require in the "Notes" field or contact the Rimex Marketing Department on (02) 4340 5599 or email marketing@rimexmetals.com.au

* Denotes required field. This form will not send unless these fields are filled out.

Company Name:
Contact Name*:	A value is required.
Address*:	A value is required.
Suburb*:	A value is required. A value is required.
Postcode*:	A value is required.
State*:
Email:
Telephone:
Position/Occupation:
Project/End Use*:	A value is required.
Required Date:	A value is required.

SAMPLE 1

Type of Metal:
Pattern:
Finish:
Colour:
Size:
Quantity:

SAMPLE 2

Type of Metal:
Pattern:
Finish:
Colour:
Size:
Quantity:

SAMPLE 3

Type of Metal:
Pattern:
Finish:
Colour:
Size:
Quantity:

SAMPLE 4

Type of Metal:
Pattern:
Finish:
Colour:
Size:
Quantity:

Notes:	Please type your notes or additional sample request here