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

Frame Color (check one):	Bronze White Mill Almond Desert Sand Champagne
Screen Mesh (check one):	Charcoal Fiberglass Gray Fiberglass Charcoal Aluminum Brite Aluminum
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 11/16"	1/4" X 3/4"	3/8" X 3/4"	3/8" X 3/4"

91007	91015	91021	91088	91052

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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Truth Hardware Color Chart | Window Screen Quote Form

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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