Get Off The Furniture!
order
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ORDERED By:
Name: _______________________________________________
Address: ____________________________________________________
City, State, Zip: _____________________________________________________ PHONE #:______________________________________________
Fax #: ________________________________________________
EMAIL: ______________________________________________
PAYMENT: CASH CHECK VISA MASTERCARD
(Circle Payment)
CARD #: _________________________________________
Expiration Date: ______________ SPECIAL INSTRUCTIONS: | |||||||||||||||
Please print form, complete and fax or mail to:
Get off the furniture!
Thank you for your order
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