
Fabric Sample Order Form
Qty Fabric Sample SKU
© 04/2014 Lutron Electronics Co., Inc.
I
P/N 368-3531 REV A
Customer Service 1.888.LUTRON1
I
Fax 610.282.8321
Please enter your shipping information
If you are a Lutron Shade Dealer,
please enter you account information
First name _________________________________________ Account number ___________________________________
Last name ________________________________________ Company name ___________________________________
Address __________________________________________ Company address __________________________________
City _____________________ State _____ Zip __________ City _____________________ State _____ Zip __________
Country ___________________________________________ Country ___________________________________________
Phone ____________________________________________ Phone ____________________________________________
Email _____________________________________________ Email _____________________________________________