I have read and verified
that all of the above information is correct and hereby give my approval
to process this order. Submission of this form along with down payment signifies
agreement with the preceding terms.
Customer Name: __________________________ Customer Signature:
__________________________ Date:______
Phone
419-684-9582
Homestead
Hardwoods
Fax 419-684-9712
Billing name & address:_________________________________________________________________________________________
__________________________________________________E-Mail:_____________________________Fax:____________________
Home phone:
_________________________ Cell phone:_________________________Work
phone:___________________________
Delivery name
&
address:____________________________________________________________________________________
________________________________________________________________________________________________________
Name & daytime phone
of contact person for
delivery:_______________________________________________________________
Is this a residential
or a
commercial delivery? (circle
one) Do you
want lift gate service at $45 extra? yes
or no
Visa/MC
number:________________________________________________________
Expiration:_________________Name
on card____________________________________3 digit number on back of
card_________
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