Tables & Chairs Order Form

SHIP TO: PLEASE PRINT Name ____________________________________________________ Street Address _______________________________ Apt. # ________ City ______________________ State _______ Zip ________________ Phone (______)________________ Email _______________________

METHOD OF PAYMENT (NO CASH or COD):  Visa   Master Card   Discover   Money Order   Personal Check Credit Card # __________________________ Expiration Date ______________ Signature as it appears on card _______________________________________

DESCRIPTION	QUANTITY	AMOUNT	TOTAL
Plain Oak Chair		$ 94.00
Oak Highback Chair		$110.00
Fancy Oak Chair		$110.00
Cherry Highback Chair		$130.00
Walnut Highback Chair		$130.00
Extra Large Table		$120.00
Large Table		$108.00
Medium Table		$ 98.00
Small Table		$ 88.00
Coffee Table		$ 48.00
Stool		$ 38.00
Subtotal
PA Residents add 6% Sales Tax (7% in Allegheny County)
Shipping
TOTAL

Merchandise Total Shipping Rate $49.99 & Under $12.50 $50.00 to $79.99 $14.50 $80.00 to $99.99 $18.50 $100.00 to $159.99 $22.50 $160.00 & Over Email for Rate

Please print this form, fill it out completely, and mail to: The Basket Man 4960 William Flynn Hwy. Suite# 6- PMB 136 Allison Park Pa. 15101

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