Blaine Distribution 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
* Select
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
Installed on
Sill Rail
* Select
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
Installed on
Left Rail
* Select
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
Installed on
Right Rail
* Select
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
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
