Order Form | Loti Corp

Order Details

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Company

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Ordered by*

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Phone*

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Email

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Purchase Order #

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Sidemark

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Billing and Shipping Address

Bill to Address*

Street Address City State ZIP Code

Bill to same as Ship to

Ship to Address

Street Address City State ZIP Code

Payment

Payment Type

On Account
Call for Credit Card
Use Credit Card on file

Contact Name for Credit Card

Phone Number for Credit Card

Product Details

Please complete all fields below so we can confirm your order. Use the codes below to complete the form:
Product Codes: GL - Gem-Loc Edge and Gem-Loc Backsplash Cap, BL - Bevel Edge, BLBS - Bevel Backsplash
Profile Codes: FB - Gem-Loc Edge Flatback, Bevel Edge, or Bevel Backsplash, TG - Gem-Loc Edge Tongue & Groove, T - Gem-Loc Edge Tongue, BC - Gem-Loc Backsplash Cap Tongue & Groove, BCF - Gem-Loc Backsplash Cap Flatback

Product Code	Profile Code	Lam Style-Finish Code / Insert Color	Quantity

Expedited (RUSH) Manufacturing - 30% upcharge

Special Notes

You will receive an order confirmation by email with pricing, availability, ship date, and ship rate shortly.

Name

This field is for validation purposes and should be left unchanged.

Laminate Countertop Edge Order Form

Order Details

Billing and Shipping Address

Payment

Product Details

Special Notes

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