Order Form

ORDER FORM

PLEASE FURNISH ALL INFORMATION REQUESTED
(ALL INCOMPLETE FORMS WILL BE REJECTED)

Contact and Shipping Information

First Name:
Last Name:
Company(If applicable):
Street Address:
City:
State:
Zip:
Day Time Phone:
E-mail Address:

You are ordering:

Hardwood / Laminate Carpet Vinyl

Manufacturer:
Style:
Color:
Size of your floor:	Sq.Ft. Sq.Yd.

PAYMENT INFORMATION

Please select the payment method you are using:

Card Number:
Expiration Date:
Name on Card:

Please send us any additional comments:

A COPY OF YOUR CONTRACT WILL BE MAILED TO THE ADDRESS YOU SPECIFIED. PLEASE BE SURE TO REVIEW OUR BUYING INFORMATION / SALES POLICIES. REQUEST FROM UNKNOWN ORIGIN WILL NOT BE PROCESSED

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