product request form

Product Information Request Form

This form is to request pricing and availability for products not shown in this internet store catalog. Your information is strictly for use by WALSER'S and will not be given out to anyone else for any purpose.

If you have a customer code assigned from either our e-mail or order registration procedures, please insert your assigned customer code here:

Product Requests
(Be as complete as possible and state brand names, models, styles, sizes, colors, series, quantities, etc.)

E-mail Address (required)

Additional E-mail Address

Telephone

Additional Telephone

LOCATION INFORMATION For Shipping Considerations
Name (required)
Company Name
Street Address
Address (cont.)
City (required)
State/Province (required)
Zip/Postal Code (required)
Country (required)

NOTE: If you wish to place orders with us, you must also complete our Order Registration Form.

If you wish to receive notifications of special sales and new products, you must complete our E-Mail Registration Form.