Blaine Custom Orders


Customer Name:
Account Number:
Address:

City:	State: Zip Code:
Phone Number:	Ext: (Enter Phone: xxx-xxx-xxxx)
Fax Number
Contact Name:
Email:

Screen Types

No. of Screens Needed:		Size:	(width)	(Height)
	*Minimum order of 6 screens. Can be a combination of multiple sizes

Frame Gauge (check one)	.019 (standard) .024 (optional)
Finish (check one):	Bronze White Almond Unpainted Aluminum
Screen Cloth (check one):	Charcoal (Gray) Aluminum Brite Aluminum Black Aluminum Charcoal Gray Fiberglass (Black) Fiberglass
Crossbrace Required (check one):	Yes No
Horizontal:	inches up from the bottom
Vertical:	inches from the right rail

Screen Selection (Please check frame number)

5/16" X 3/4"	7/16" X 3/4"	1/4" X 3/4"	3/8" X 3/4"	3/8" X 3/4"

91007	91016	91021	91088	91052 (.019 gauge only)

Screen Hardware (Locate hardware placement on chart below)


If no hardware is required, please check here
Hardware Location	Number	Qty	Position on Frame (inches from end - tip or corner)
Installed on Headrail
Installed on Sill Rail
Installed on Left Rail
Installed on Right Rail

1. Plain Plastic Screen Clips

2. Frame Tension Spring

3. Clip & Screw

4. Knife Latch

5. Frame Tension Spring

6. Lift Tab

7. Metal Plunger

8. Plastic Plunger

Signature of Authorized Buyer		Title		Date

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Blaine Window Hardware Inc.
17319 Blaine Drive
Hagerstown, Maryland 21740
1-800-678-1919
1-301-797-6500
1-888-250-3960 fax
1-301-797-2510 fax
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