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Fax: 818-981-6777 or email to sales@1allchairs.com Chairs and Tables Direct Los Angeles, CA 90077 800-914-1969 Date_________ Billing Info Name: _______________________Company:____________________________ Address:___________________________City:______________ St:___ Zip:_____ Telephone#: _____________ Fax#: ______________ Email: _____________ Shipping Info ___ Check if same as Billing Name: _____________________Company:____________________________ Address:___________________City:________________ St:___ Zip:_____ Telephone#: _________________ Fax#: ____________ Email: _____________ Style # and Description_______________ QTY________ PRICE_________ 1.________________________________________________ _____ ______ 2.________________________________________________ _____ ______ TOTAL________________________________________________________ Before we confirm this order, we will call you with the exact shipping cost. __ Check or money order enclosed. Checks must be US bank checks. __ Wire transfer: ABA#- 121000358 Account #- Call for Account Number __ VISA __ MasterCard ___ American Express ____ Name as it is on card __________________________________ Card #: ___________________________________ Expire MM/YR: _________ Code Number (last three digits on back of card):________
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