A ~ DESIGN & SHOWROOM INFORMATION E ~ CLIENT ...

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TERMS: Price quotes honored for 60 days. Balance due before delivery. 50% deposit required on all orders.

A ~ DESIGN & SHOWROOM INFORMATION

E ~ CLIENT INFORMATION

ORDER DATE:

ACCOUNT #:

SALES ASSOCIATE:

PATTERN:

DESIGNER NAME:

COLLECTION:

ADDRESS:

QUALITY: CONTENT:

TEL:

B ~ DIMENSIONS

EMAIL:

STANDARD:

6x9

8x10

9x12

10x14

OR CUSTOM: WIDTH

X LENGTH

CELL:

SHIP TO ADDRESS: TEL:

CELL:

EMAIL: END USER’S NAME:

W

ADDRESS: TEL:

CELL:

EMAIL: L

PO#:

SIDEMARK: COST P/SQ.FT: $0.00

C ~ COLOR SAME AS SAMPLE; Color reference#s:

OR

RUG COST:

$0.00

PAD:

$0.00

LABOR:

$0.00

FREIGHT:

$0.00

TOTAL:

$0.00

DEPOSIT:

$0.00

BALANCE:

$0.00

TOTAL SQ.FT: 0.00

CUSTOM; Color reference#s: CHECK #:

Custom orders require artwork renderings indicating colors and placement. Please attach documents to this order form along with any references for color match (i.e.; poms, pantone chips, fabric swatches, etc...) D ~ SPECIAL INSTRUCTIONS

AMEX

DATE: MASTERCARD

VISA

CARD NUMBER: EXP DATE: NAME ON CARD: SIGNATURE:

To expedite your order, you can pre-authorize to charge the balance to the credit card information above. Please initial here ___________________ Variations in color, texture, placement and irregular weaves are a natural characteristic of hand made qualities and are not considered manufacturing defects.

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245 Central Avenue South, Bethpage, NY 11714 • 800.538.1880 • Fax 516.293.1734 • Brunschwig.com