Custom Mirror Order Form

Simplify the process—complete this form with your customer.

Retailers email to Remer Customer Service: sales@remer.com.au

Customer Name:

Company Name:

Contact Phone:

Email:

MIRROR SHAPE

Rectangle/Square

Rounded Rectangle/Square

Round

Oblong 1

Oblong 2

Arch 1

Arch 2

Other (Please supply image to retailer)

MIRROR SIZE (MAX 1000MM x 2000MM)

Width (mm):

Height (mm):

FROSTING

No Frosting

Edge Frosting

Instep Frosting

LIGHTING (CRI 90 STANDARD)

Warm White (2700K)

Standard White (4000K)

Cool White (6500K)

Adjustable Colour Temperature (2700-6500K)

Requires touch sensor

FEATURES

Demister:

Yes

Bluetooth Speakers:

Yes

CONTROLS

Hardwired (Wall switch not included)

Touch Sensor with Guide Light (one per feature)

Please indicate sensor location in next section

Other

TOUCH SENSOR LOCATION (IF SELECTED)

Bottom Centre

Bottom Left

Middle Left

Bottom Right

Middle Right

ACCESSORIES

Mirage Makeup Mirror:

Yes

Mirage Attachment Zone:

(cannot be same location as touch sensor)

Bottom Left

Middle Left

Bottom Right

Middle Right

QUANTITY

ADDITIONAL COMMENTS