STAPLE TOP OF SAMPLE HERE [ (TOP OF CHAIR) PHOTOCOPY AND USE THIS FORM AS OFTEN AS NECESSARY * SAMPLE & AUTHORIZATION REQUEST FORM ae [__] PREVIOUSLY APPROVED FABRIC IF THIS IS A PREVIOUSLY APPROVED FABRIC, A NEW AUTHORIZATION NUMBER MUST BE ISSUED. FAX OR MAIL THIS COMPLETED FORM TO: [] NEW FABRIC REQUEST IF THIS IS A NEW FABRIC REQUEST, FILL OUT THIS FORM WITH YOUR ATTACHED FABRIC SAMPLE (12” BY THE WIDTH OF THE ROLL} AND MAIL TO: GLOBAL UPHOLSTERY ATTN: GRACE MARTIRE 560 SUPERTEST ROAD * DOWNSVIEW, ONTARIO © M3J2M6, CANADA DATE MAILED: GLOBAL INDUSTRIES ATTN: COM CONTACT P.O. BOX 562 * MARLTON, NJ 08053 © FAX 856-596-5684 PREVIOUS RGA &: CUSTOMER INFORMATION (To Be Completed By The Dealer) DEALER/COMPANY NAME: CONTACT. BILLING ADDRESS: PHONE CTY: STATE ZIP. FAX: LOCAL GLOBAL DISTRIBUTION CENTER: DATE: FABRIC INFORMATION (To Be Completed By The Dealer and/or Mill) FABRIC NAME (SERIES) & STYLE # FABRIC COLOR NAME AND DESCRIPTION COUNTRY OF ORIGIN: MILL OR MANUFACTURER'S NAME: FABRIC CONTENT (%COTTON, “oPOLY., Y%WOOL, ETC.): = io DOES THIS FABRIC CONTAIN FILAMENT, COTTON or WOOL? WIDTH fe) DESIGNER OR SPECIFIER OF FABRIC oa CHAIRS ORDERED WITH C.O.M. FABRIC WILL BE PRICED AT CHAIR’S LOWEST AVAILABLE FABRIC GRADE PRICE. IF QUANTITY IS LESS THAN 6 ITEMS, A 10% UPCHARGE WILL APPLY. PRODUCT INFORMATION PURCHASE ORDER: QUANTITY MODEL/FRAME COLOR FABRIC DIRECTION FABRIC IS TO BE UPHOLSTERED BEING THE SAME AS THE TOP OF USE A SEPARATE FORM FOR EACH FABRIC REQUESTED. ONCE THE FABRIC HAS BEEN APPROVED AND/OR AN AUTHORIZATION NUMBER HAS BEEN ISSUED, A SET OF FORWARDING INSTRUCTIONS (FOR THE FABRIC) WILL BE MAILED OR FAXED TO YOU PLEASE NOTE: * Do not send ANY fabric without these documents and the C.O.M. Authorization Number! * GLOBAL can not be responsible for fabric received without the Approval Acknowledgement Number. * GLOBAL is not responsible for the duty and fees for the fabric to clear customs. These charges will be billed to the dealer. * Customer's Own Material. BOTTOM OF SAMPLE HERE (BOTTOM OF CHAIR) 34t EFTA00521730