You can use this form to place an order directly with Tri-State.  The information will be forwarded directly to our scheduling department.

If you would like a quote before placing an order, you can use our contact form, or call us at (845) 818-0068.

Store Name/Number

Customer Name

City

State

Zip

Phone #1

Alternate Phone #

Email Address

Item Type (Enter each item on separate line)

Model Name/# (Enter each model on separate line)

Date Submitted

Order Type

Notes

Associate Name:

Date:

Quiz: