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NSR CUSTOM SAMPLE REQUEST FORM
Fill out the form with a signature. Email, fax or mail your completed request form.
Order Request To :
Shin Textile Solutions America Inc. / NSR RIDING Dept.
Phone : 201-464-2272
Address :
Fax : 201-944-3660
Email : [email protected]
2115 Linwood Ave. 5F, Fort Lee, NJ 07024
Customer Information
Name (Representative) :
Club Name (If different from above) :
Address :
City :
State :
Zip :
Email :
Phone :
Fax :
Shipping Address : (if different from above)
Address :
City :
State :
Zip :
Sizing Sample / Design Sample (Please Circle one of them)
STYLE NAME
Short or Long Sleeve
Jersey
Short or Long Pants
Short or Long BIB
GEND
ER
SIZE
XS
S
M
L
XL
2XL
Q'ty
Unit Price
TOTAL AMOUNT
Men
Lady
Men
Lady
Men
Lady
TOTAL
* For Sizing sample, you only pay the freight and can have the samples for 14 days. If not returned in 14 days, your credit card
will be charged for the order of Sizing sample based on the Price List. Sizing sample clothing is for sizing purposes only and is
not to be worn or road tested. If samples are returned soiled or showing excessive wear, your credit card will be charged for
the item(s).
* Design sample is for you to check out actual garments you designed and approved finally with us. If your order quantity is
over 20 pieces, you only pay the freight. If not ordered within 10 days or not over 20 pieces, your credit card will be charged for
the order of Design sample based on the Price List.
Credit Card
Mastercard
Visa
Credit Card Number :
Exp.Date :
Print name as it appears on card :
Amount Authorized :
Signature :
American Express
US $
Authorized Signature :
Date :
/