Product Request Form

Please complete the following form and thank you for your interest in Jain Americas. We welcome the opportunity to serve you.

First Name:

Last Name:

Title:

Company:

Type of Business:

Address:

City:

State:

Zip Code:

Country:

Email:

Phone:

Fax:

Please send me an EX-CEL Collection Sample Kit.
(Note: Includes samples of all 4 products, plus an EX-CEL swatch book. Only one sample per request.)

Sample size:

Please send me a Product Brochure.

Please have a Jain Americas representative contact me.

Jain Americas would like your permission to stay in touch and, on occasion, send you e-mails with:

YES, I'd like to receive industry communications from Jain Americas.

Comments/Questions: