Custom Quote

*Required

*Name:

Company:

Address:

Address 2:

City:

State:

Zip:

*Email:

Phone:

Please provide as much information as possible on the following questions so that we may best help to determine the perfect product for your needs. If you provide the square footage of your project we can also provide a cost of materials.

1. *What is the current substrate you are coating?

2. What is the environment the floor and/or surface coating is being used? (check all that apply)

	inside			outside
	freezer			refrigerator
	extreme heat			extreme cold
	animal facility			other

3. What type of traffic will be used on the flooring? (check all that apply)

	foot traffic			heavy machinery
	animals			cars and trucks
	retail traffic			other

4. What properties do you need from your flooring or surface coating? (check all that apply)

	non-skid			decorative
	glossy finish			flat finish

Please list or describe any other special concerns or needs that you require for your flooring or surface coating

What is the Square Footage of your project? (this is only needed if you would like an approximate product cost quote)

300 Edwards Street • Madison, Ohio 44057 • Toll Free: 800.486.7866 • Phone: 440.428.2105 • Fax: 440.428.7091 • Email: info@chemfloors.com