Instant Fax Form

Glass Block Company      

To receive a personal quote please fill in the necessary details and fax it to: Fax 0064 - 09 2384488. Please Select all options before printing this page. To print, select File then Print or click on the printer icon on the tool bar.

 

Date:   

*Name:     

Company:

*Telephone:  

  

Fax:

*E-Mail:  

Postal Address: 

*Delivery Address:


Supply and Installation

 

Please tick if you would like blocks for supply or installation:

Supply

   

Supply and Installation

   
           

Please select an option:

         

Half blocks are available in 190 x 90 x 80mm

Flemish Half

 Qty

 

Sahara Flemish Half

Qty

 

Blocks are available in 190 x 190 x 80mm

Flemish

 Qty

 

Sahara Flemish

Qty

 

Clearview

Qty

 

Sahara Clearview

Qty

 

Savona

Qty

 

Stella

Qty

 

Light Directing

Qty

Crossribbed

Qty

 

Samba

Qty

Flemish Grey

Qty

 

Sahara Flemish Grey

Qty

 

Diagona

Qty

 

Flemish Azure

Qty

 

Sahara Flemish Azure

Qty

 

Flemish Dark Blue

Qty

 

Sahara Flemish Dark Blue

Qty

 

Flemish Bronze

Qty

 

Sahara Flemish Bronze

Qty

 

Flemish Green

Qty

 

Sahara Flemish Green

Qty

 

Marin

Qty

 

Flemish Turquoise

Qty

 

Sahara Flemish Turquoise

Qty

 

End Block

Qty

 

Flemish Corner

Qty

       
 

If only for supply please ignore rest of form.

 

If installation please fill in the following:

 

             Panel Size (in mm)

1:   Height:    

Width:  

2:   Height:    

Width:   

3:   Height:   

Width:     

4:   Height:       

Width:  

Type of Glass Block Wall:

Interior

Exterior

Straight

Curved

Stepped