COM UPHOLSTERED FURNITURE ORDER FORM
ALL INFORMATION MUST BE COMPLETE OR YOUR ORDER WILL BE DELAYED
1) Please check one of the following boxes:
I am ordering item number(s) [ ] MB190 Camden Untufted Bed
[ ] MB189 Camden Tufted Bed
[ ] MB191 Camden Nailhead Bed
to be upholstered in my own material. I have enclosed the specified amount of continuous yardage fabric
(multiple pieces cannot be accepted).
I am ordering the following size
..
[ ] Twin [ ] Full [ ] Queen [ ] Fing.
[ ] My fabric (in the amount specified) is being sent separately, labeled with my name and address.
2) Please complete, if applicable:
Place the design/pattern of my material in the following manner:
______________________________________
________________________________________________________________________________________________
3) Please provide all of the following information:
Ship my order to the following name and address:
__________________________________________________
Daytime phone (______)
______-________
__________________________________________________
Evening phone (______)
______-________
__________________________________________________
Catalog source code (numeric code in the shaded bar on the catalog's back cover)
______________
4) Please indicate amount and method of payment:
Item Base Price _______ units @ $________________ each =
$____________
Item Base Price _______ units @ $________________ each =
$____________
Tax: 7% (
GA buyers only
), 8% (
city of Atlanta only
), 6.5% (
OH buyers only
)
$____________
Standard S&H Charges
$____________
Oversize Charges
$____________
TOTAL PRICE
$____________
[ ] C
HARGE
: Circle type of card and fill in all blanks.
V
ISA
D
ISCOVER
M
ASTERCARD
A
M
E
X
Account #
______________________________________________________________________________________
Expiration Date (required)
________________________________________________________________________
Cardholder's Signature:
__________________________________________________________________________
Cardholder's Billing Address (if different from ship-to address above):
____________________________________
________________________________________________________________________________________________
[ ] C
HECK OR
M
ONEY
O
RDER
E
NCLOSED
: Make check payable to Ballard Designs. Sorry, no CODs or cash.
Orders paid by check will be held until check clears.
5)
I request that Ballard Designs follow the above instructions. I HAVE READ THIS INFORMATION PACKET
CAREFULLY AND UNDERSTAND THAT BECAUSE THIS IS A CUSTOMIZED ORDER, CHANGES OR
CANCELLATIONS ARE NOT POSSIBLE ONCE PRODUCTION HAS BEGUN. I recognize that the delivery
of my COM order is based upon when Ballard receives the appropriate yardage from me. Finally, I acknowledge that
COM ITEMS ARE NOT RETURNABLE FOR REFUND OR EXCHANGE.
Signature_______________________________________
Date
_______________
6) When complete, send this form to:
Please clip a piece of your fabric
to the front of this form with
the correct side facing up. Then,
mail your fabric and the order
form to us, using the label at left.
F
FA
AB
BR
RI
IC
C
F
FR
RO
ON
NT
T
OP227 08/06
R
ETURN
T
O
:
________________
____________________________
____________________________
For convenience and accuracy, cut out the box above and use it as a mailing label on your package.
ATTN: B
ALLARD
D
ESIGNS
C
ALL
C
ENTER
COM D
EPT
. - G
ATE
51
5568 W
EST
C
HESTER ROAD
W
EST
C
HESTER
, OH 45069
