8” x 10” Sample Request Customer Information Send to: Date: _____________________________________________________________________ Customer Name: __________________________________________________________________ Customer: ______________________________________________________________ Architect: ___________________________________________________________________________ Project Name: _________________________________________________________ Address: _____________________________________________________________________________ Order N : ________________________________________________________________ City: ___________________________________________________________________________________ Location:________________________________________________________________ Province: ______________________________ Postal Code: ___________________________ o Phone: __________________________________ Fax: ______________________________________ 8” x 10” Sample Flush Construction 1 3/4” ❏ ❏ 1 3/8” Construction Qty ❏ 8600 (PC) .......... ❏ 8500 (PC) .......... ❏ PC5 (PC) ............ ❏ 9100 (HC) ......... ❏ 9600 (HC) ......... ❏ 8100 (PC) .......... Other: ______________________ MO Construction ❏ ME Qty __________ 9500 (HC) ............. __________ 6000 (LSL)............ __________ 7000 (LVL) ............ __________ AF45 (AF) ............. __________ AF60 (AF) ............. __________ 5045 (MC) ............. ❏ ❏ ❏ ❏ ❏ ❏ ❏ VE ❏ Other: ________________________________ 20 min. Construction ❏ 5090 (MC) ......... ❏ 7600 (LVL) ........ ❏ 8512 (LL) .......... ❏ 8516 (LL) .......... ❏ 8522 (LL) .......... ❏ Qty Construction __________ 5060 (MC) ......... __________ 8526 (LL) ........... __________ __________ 4000 (EXT) ........ __________ __________ __________ __________ __________ Raised panel ..... __________ Flat panel ........... __________ Other: __________ Other: ❏ Qty ❏ ❏ ❏ ❏ ❏ ❏ __________ __________ __________ __________ __________ __________ Note: Sound-rated or custom door samples will be presented to customer and/or architect by a sales representative. Species White Birch.................. Natural Birch ............... Hardboard ................... ❏ ❏ ❏ ❏ White Oak ............ ❏ NAUF/FSC ........... ❏ Red Oak ................ White Maple ........ White Ash ............ ❏ ❏ Cherry .......... ❏ Rift Cut .................... Walnut ......... ❏ ❏ HDF..................................... ❏ ❏ ❏ ❏ ❏ African Mahogany .......... Other: Veneer Cut Rotary Cut .............. ❏ Flat Cut ................... ❏ Quarter Cut ............ Other: Grade A (Premium) .................. ❏ AA (Special) .............................. ❏ B (Economy) ........................ ❏ ❏ ❏ Medium Mahogany BS-12-25 ❏ Dark Mahogany BS-34-25 ........ ❏ Cognac Brown BS-26-25 ....... ❏ Medium Brown BS-30-25 .. ❏ Other: ❏ Finishing Clear BC-00-25 ............... Golden Oak BS-17-25 Wild Cherry BS-21-25 Other: ❏ Dark Brown BS-13-25 ......... ❏ Mocha Brown BS-29-25 .. ❏ ❏ ❏ Opaque Paint .............. ❏ ❏ Primed 1 c. BP-00-01 Primed 2 c. BP-00-02 Rev. OCT. 15, 2010 Note: To order a full-size mockup door, please fill up our regular order form. Toll Free: 1 800 804-5666 www.baillargeondoors.com