Printable Order Form

 Printable Order Form (Retail):

 

To submit an order, please print this form and mail to:

 

Accents in Wood

2005 W. Avalon Rd..

Janesville, Wi  53546

 608-756-0970

 

 

 

Please allow 10 days for shipping.

 

Items Ordered:

 

Item Number

Item Title

Size

Color

Quantity

Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plus 5.5% sales tax

 

 

 

Shipping and handling $10.00 for 1 item, 15.00 for more than 1 

 

Total

 

 

For more items, please print and include a second form.

 

Customer Information

 

*First Name ________________________

*Last Name ________________________

Company     ________________________

*Email         ________________________

Phone          _________________________

 

Credit Card Information

 

*Card Type  ________________________

*Cardholder’s Name As Shown On Card  ___________________________________

*Card Number ______________________

*Expiration Date (mmyy)  ____ / ____

*3 Digit Security Code   _______________

 

*Required fields.

Billing Address

 

*Address Line 1  ______________________

*City  _______________________________

*State/Province _______________________

*Country _____________________________

*Zip/Postal Code ______________________

 

Shipping Address (if different from billing address)

 

Ship To Name __________________________

Address Line 1 __________________________

City __________________________________

State/Province __________________________

Country _______________________________

Zip/Postal Code _________________________

 

 Thank you for ordering from Accents in Wood. If you have any questions, please do not hesitate to contact us by phone at: 608-756-0970, or by email at: accentsinwood@charter.net

 

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