Plastic Hand Shaped Chairs

Order Form

SOLD TO

Name:

Address:

City, State, Zip:

Phone #:

E-Mail:

Please mail payment

and order form to:

Shawn Barbagallo

1004 Westchester Dr

Rockford, IL 61107

Order form can be faxed to: 815-282-3291

Orders can be called in to: 815-988-7747

(9 A.M. – 7 P.M. Central Time)

Orders can be e-mailed to: HandShapedChairs@aol.com

We accept Credit Cards (through http://www.paypal.com/, user ID (HandShapedChairs@aol.com), Cashier's Check, Money order or Personal Check.

* Personal Checks require 7-10 business day hold to clear

ITEM	QUANTITY	UNIT PRICE	TOTAL PRICE
		Total
	Shipping & Handling
		Grand Total

* Prices and availability are subject to change at any time.

Ó 2001 - 2008 www.HandShapedChairs.com