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

If you would like a quote before placing an order, call us at (845) 818-0068.  For Big Lots orders, please go to our BIG LOTS ORDER PAGE.

    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: