High Point Furniture, NC Order Form

Qty.	Model Number/	Manufacturer/Description	Price
		Shipping/Handle	$
	Date:	Sale-Tax	$
			$
		Total	$

Sold to: (E-MAIL address) ___________________________________________

Name______________________	Ship to: (fill out only if different)
Address____________________	Name_________________________
City/State/Zip______________	Address_______________________
Day Phone_____________________	City/State/Zip_________________
Night Phone_____________________	Contact Phone________________________

To order...please print, fill out order form and mail, along with merchandise payment, to:

High Point Furniture, NC, 2318 West English Road, High Point, NC 27262

Business Number: 336.886.7789 Fax: 336.861.6774

...we appreciate your business...www.highpointfurniturenc.com

Credit Card: MASTERCARD *** AMERICAN EXPRESS *** VISA *** DISCOVER

Credit Card Number: ______________________________________________

Expiration Date Month/Year: ___________________

Code on Back: ______________________

Signature: _____________________________________________________