CI2 Custom Strikeoff Order Form

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Custom Interior Imaging Strikeoff Request Form

The following form will submit your strikeoff request information to CI². If you would like to upload an image file, please contact Custom Interior Imaging to obtain a username and password for our File Upload page. If you have already submitted a file, please specify the pattern name and any details in the Special Instructions box below.

Ordered By: Ship To:

Name:

Email:

Company:

Address1:

Address2:

City:

State: Zip:
Phone:
Fax:
Check if Shipping Address Same as Order By
(If checked, fill out only the "Ship Via" information in the section to the right) Name:

Email:

Company:

Address1:

Address2:

City:

State: Zip:
Phone:
Fax:
Ship Via:

Order Details:

Pattern Name:
Project Name:

Color No. Paint Manufacturer Chip No.

Ground -

Color 1 -

Color 2 -

Color 3 -

Color 4 -

Color 5 -

Color 6 -

Color 7 -

Color 8 -

Color 9 -

Special Instructions:

216 Industrial Drive Ridgeland, MS 39157-2703 1-866- 530-0020 Fax (601) 956-5809