Distributor Order Form

Please fill out and submit the information below to receive a quote on your Perma Blend order. Upon receipt, someone from our team will contact you with an accurate quote on your order. Thank you for your interest in Perma Blend pigments.

Purchasing Agent's Name*

First Name
Last Name
Purchasing Agent's Phone #

Phone
Purchasing Agent's Email Address

Email
Business Name

Pigment Name 1/2 Oz 10mL Single Service Packs
Amber
Apricot
Ash Grey
Auburn
Baby Blue
Blackish Brown
Blanc
Blue Iris
Blushed
Bronzer
Brunette
Burnt Sienna
Butterscotch
Cafe Cream
Camouflage
Cheeky
Chocolate Kiss
Cinnamon Stick
Coal
Coco
Creme De Pink
Darkest Brown
Double Black
Espresso
Eyeliner Black
Forest Brown
Fudge
Ginger Brown
Latte
Mallard
Martini Olive
Mauve
Olive Branch
Olive Green
Passion Red
Plumb
Pumpkin
Queen of Hearts
Raisin
Roots
Roxy Brown
Rustic
Sphinx
Sunkissed
Tan
Taupe
Terra Cotta
Tina's Gold Sunrise
Tres Pink
Ultra Violet
Vanilla Chai
Vivid Blue
Walnut
Wildflower
Thin Shading Solution
Thick Shading Solution
Soft Yellow Corrector
Pumpkin Corrector
Olive Corrector
Golden Corrector