Reglet Mounted Counter Flashing Order Form

Type of Order(Required)

Company Name(Required)

Contact Name(Required)

Email(Required)

Contact Phone(Required)

Contact Fax

Project Name / Number(Required)

X (Front)(Required)

Y (Flange)(Required)

Z (Reglet)(Required)

Type of Material(Required)

Other, please specify:(Required)

24 ga Kynar Color(Required)

Quantity (sold in 10LF sections)(Required)

Other Notes/Instructions

Pick-up or Delivery(Required)

Shipping Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Jobsite Contact:(Required)

Jobsite Contact Phone(Required)

Expected Pick-up or Delivery Date(Required)

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