Sample Request Form - Georgia Carpet Industries

Flooring Sample Order Form

Use this form to order samples that are not shown in our shopping cart. We purchase from all major mills and all of the styles available are not shown on our website.
*Note: Three swatches are free, additional samples are $5.00 each. Samples will be shipped by FedEx. Please let us know the Style Name & Colors you want to order.

Sample Form Information:

_{* Please fill out required fields}

Please let us know the style name, style number and also include the Color Name or Color Number of the sample you are requesting. For example: 4A229 Atlantic I 953 Russet : *

Email *

Re-Type Email *

First Name *

Last Name *

Company Name
(If Applicable)

Mailing Address *

Shipping Address*

City *

State *