LOGOMACSM.GIF (2574 bytes)                                                                                      TELECHANNEL.GIF (6016 bytes)

EDfI Order Form Date:Year Mo Day
Cust#

:

PO#
Bill to Name:
Bill to Address:
Bill to City, State & Zip:

ST: 

ZIP

 

___________________________________________________________________________________
Ship to Name:
Ship to Address:
Ship to City, St & Zip: ST: ZIP

Please choose the qty and item you would like to purchase:
                                 DUX MODEL 1001 DUX NEW BED
                                 DUX MODEL 1001 MEDIUM 31.5X79 DUX MODEL 1001 MEDIUM
                                 AVANTI 740 GLASS DOUBLE AVANTI FRGLS DRS 23W
                                 AVANTI BLACK WIDE BAY AVANTI 17" GLASS SHLF

                                    PHONE TABLE LIGHT MAHOGANY

                                  DUX MODEL 1001 MEDIUM 60X80"

                                   MODEL 1001 MEDIUM 71X79

                                   ANNIKA TABLE 18"D 11"H
 

 

Internal use only

 LOGOMACSM.GIF (2574 bytes)


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