Sample Request Form

First name*

Last name*

Email*

Phone*

Company name

Address*

Message

Project Details*

Approx Quantity Required*

Would you like to send an image to reference from

Brick Type Required - 1*

Brick Type Required - 2

Brick Size*

Size is for our reference, sample will generally be supplied in 65mm, please contact us directly if sample is required in a particular size.

Furness Brick & Tile Co Ltd, Dalton Road, Askam-in-Furness, Cumbria. LA16 7HF.

email: info@furnessbrick.co.uk Tel: 01229 462411

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