Please print and fax the
following form to place your order. This form
may be filled out online, however in order to
ensure your security, we recommend entering
critical information after printing.
Alternatively, you can save this page (using
your browser's File-Save command), fill it out
off-line, and then print and fax the order form
to (570) 476-7611.
Complete and Fax
this form to (570) 476-7611
Customer
Information
First Name
Last Name
Street
Address
City
State
Zip
E-mail
Address
Phone
Fax
Product
Selection
Pattern
Color
Width
Length
Price
Quantity
Total
Item
Total :
Small Order
Charge
A small
order charge of $10.00 will be applied
to orders less than $50.00.
Small
Order Charge :
Shipping
Standard UPS shipping rates will be
applied. Since UPS rates are determined by
package weight and shipping address, your
shipping rate will be determined after your
order is packaged. You have the following
choices regarding your shipping charges:
Apply
standard UPS shipping charges and proceed with
my order.
If confirmation is needed,
please call our shipping department after 24
hours at (570) 421-7470
Shipping :
Subtotal (Item Total +
Small Order Charge + Shipping):
