Furniture Gallery Order Form

• Our Delivery Area is a 300 Mile Radius of Our Lewes, Delaware Store Location •

* Note: Please call 1-888-808-6104 or E-Mail us to inquire about wood types before completing this form, printing it out, and mailing it to us or calling us with your order.

SHIP TO:

Name ______________________________________________________________

Address ____________________________________________________________

City __________________________________________ State ___ Zip __________

Phone Number (Important) _________________________________

E-Mail Address (Important) ________________________________

* Your phone number and e-mail address will be used to confirm your order or clarify questions we may have about your order.

BILL TO: (If other than Ship To)

Name ______________________________________________________________

Address ____________________________________________________________

City __________________________________________ State ___ Zip __________

Phone Number (Important) _________________________________

E-Mail Address (Important) ________________________________

* Your phone number and e-mail address will be used to confirm your order or clarify questions we may have about your order.

Credit Card Information :

Name (As it appears on your card)______________________________________________________________

Address ____________________________________________________________

City __________________________________________ State ___ Zip __________

V-code (last 3 digits on the back of your card after signature) __________________________

FINISHING:

Unfinished Stained Painted

Finish Description (Explain how you want piece finished)______________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Note about Finishes: If you would like to see color samples before ordering, please call us at 1-888-808-6104 or E-Mail us with your Name, Address and Phone Number. Better yet, if you will be in our area, stop by to see actual finished wood pieces in different colors.

QTY.
ITEM#
SIZE
DESCRIPTION
PRICE
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* Shipping
_______
 Total Price
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* Shipping Note: Please call us at 1-888-808-6104 or E-Mail us for shipping costs before submitting order. Some items may be too large to economically ship out of our delivery area.

If the item is going to be delivered on our company delivery truck, please print out and fill up the delivery form.

Delivery Information (Please note that your delivery time is a two hour block, we try our best to be prompt but please note that circumstances do come up)

Your name:

Your address:

Nearest Cross Streets:

Directions and special instructions:

Contact Information (please note the best number to call):

Home-

Work-

Mobile-

E-mail Address:

Site Information (please note selected location)

Ground floor

Upstairs # of flights (extra charge will be added)

Downstairs # of flights (extra charge will be added)

Be ready for delivery and move all obstacles for we will not move your existing furniture or electronics

Customer Acknowledgement

I acknowledge that I have read this information and fully understand the delivery process.

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Customer Signature Required Date

METHOD OF PAYMENT:

Check VISA MasterCard

Credit Card Name ___________________________________________________

Credit Card Number _________________________________________________

Credit Card Expiration Date ___________________________________________

Signature __________________________________________________________

EXCHANGES OR RETURNS: Exchanges or returns for STORE CREDIT ONLY on all unfinished merchandise. All merchandise must be in perfect condition and accompanied by a receipt. Custom finished, factory finished or special ordered merchandise is non-returnable. Returns are subject to a re-stocking fee or loss of deposit.

Arthur W. Brown - Quality Furniture

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