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:
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Item Number
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Item Title
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Size
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Color
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Quantity
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Price
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Plus 5.5% sales tax
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Shipping and handling $10.00 for 1 item, 15.00 for more than 1
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Total
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For more items, please print and include a second form.
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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.
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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 _________________________
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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
