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This form is to request a NATIQ Intelligent Choice Certificate (NICC) on your client’s behalf that will acknowledge their contribution to the environment by recycling old carpet (if applicable) and by choosing and installing a new NATIQ nylon carpet.

In order for you and your client to receive a personalized NICC as well as our free carpet cleaning guidelines, you must supply the information in sections 1, 2, 3 and 4 about you, your client, the disposal of the old carpet (if applicable) and the purchase of the new NATIQ nylon carpet.

 

Specifier or Contract representative information
* Denotes required fields.

*First Name
Last Name
Company Name (if applicable)
Profession and/or job title	Interior Designer Decorator Architect Mill Contract representative Other:
Fields of practice	Residential Commercial Office / corporate Hospitality Healthcare
Age range	18-25 26-34 35-45 46-59 60 and more
*Address
*City
*Province or State	-Select-AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNunavutN.W.T.OntarioPrince Edward IslandQuebecSaskatchewanYukon
*Country
*Zip
*Email
*Please re-enter Email
	Yes, I would like to receive by email a printable copy of my clients personalized NATIQ Intelligent Choice Certificate (NICC), acknowledging our contribution to the environment by choosing and purchasing a carpet made with 100 % recyclable nylon fiber.

 

Carpet owner information

*First Name of the carpet owner
Last Name of the carpet owner
Company Name (if applicable)
Profession and/or job title of the carpet owner
*Address where the carpet has been or will be installed
*City
*Province or State	-Select-AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNunavutN.W.T.OntarioPrince Edward IslandQuebecSaskatchewanYukon
*Country
*Zip
This address is a:	single-family home multi-dwelling home business (restaurant, store, etc.) private or public office healthcare facility hospitality establishment (hotel, motel, etc.)
	Yes, I would like my client to receive, at this address, a framed and personalized NATIQ Intelligent Choice Certificate (NICC), acknowledging our contribution to the environment by choosing and purchasing a carpet made with 100 % recyclable nylon fiber.
*Email
*Please re-enter Email

 

Old carpet information (if applicable)

Did your client replace his/her old carpet with this new NATIQ one?	Yes No
If yes, how did your client dispose of the old carpet?	Sent it to landfill Sent it to a local eco/depot/center Used NATIQ 360° ; Recycling Program Used Nylene 360° ; Recycling Program Used another recycling program: (name and company)
What was approximately the quantity of the old carpet?	sq. yards (imperial) sq. meters (metric)

 

New NATIQ carpet information

Name of the new NATIQ carpet style
Colour, name or number
Fiber type	NATIQ WORK NATIQ ENVIROWORK NATIQ HOME NATIQ ENVIROHOME NATIQ CONDO NATIQ ENVIROCONDO
Name of carpet manufacturer	Barrett Carpet Mills Blue Ridge Industries Constantine Fortune Contract Kraus Carpets Marabella Contract Nood Fashion Venture Carpets
Name of carpet retailer or dealer where purchased
Quantity purchased	sq. yards (imperial) sq. meters (metric)
Purchase date	-Select- January February March April May June July August September October November December -Select- 20082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971
General comments (max 200 words)
	Yes, I would like to receive information from Nylene Canada on products, services and special offers that may be of interest to me.
Please review all entries.

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