Order Form "*" indicates required fields CompanyAddress Street Address City State / Province / Region ZIP / Postal Code PhoneFaxPO #Apartment Number*Apartment Size*Products Needed:* Our Standard Carpet Our Standard Carpet Padding Our Standard Vinyl Other Carpet Other Padding Other Vinyl Choose Carpet Color07Beach HouseBear ClawBiscottiChipmunkCoffee FrostDriftwoodFawns LeapGrahamGrizzlyHarness BrownHebal TeaJavaMaple SyrupMesa ShadowMilk ChocolateQuailThundercloudVistaWarm BeigeChoose Carpet Padding1/2 Inch Premium1/2 Inch Standard1/4 Inch 8lbs3/8 Inch 8lbs3/8 Inch StandardChoose Vinyl6600766025660806608266085660866608966155661566615866177661806618266232X-2001X-2010X-2017Take Up Yes No Vacant Yes No Furniture Yes No Requested Installation Date* MM slash DD slash YYYY CommentsPlease note that submission of this form does not confirm an order with Lloyds Carpet World. To begin an order request, please submit the form above and click “Request Order.” One of our friendly staff will contact you to complete the order.
