Order Form for Fabric/Wallpaper/ Trim/ Lamps/Tables/Mirrors

Contact Information
* Indicates required fields.
*
	Name
*
	B&F Acct #
*
	Company
*
	Telephone
	Fax
*
	E-Mail
Mailing Address
*
	Street
	AddI Address
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	City
*	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AB BC MB NB ON QU
	State
*
	Zip
*	United States Outside US
	Country
Ordering Information
*
	Today's Date
	Your P.O. #
	Specifier (Contract Accounts)
*
	Regular Order	Reserve
	Cut For Approval	Check Stock / Price
Specify Order Items
*
	Item Number
	Description
	Color
*
	Quantity
Shipping Address/Method
	Ship To
	Attn
	Address
	City, State, Zip
	Sidemark
	UPS FedEx US Postal Service
	Ship Via
Notes
	Please include any special instructions or questions.
	Thank you for your order/reserve. You will receive an acknowledgement within the next 24 business hours. Please refer to your reference number when contacting your local Brunschwig & Fils showroom or feel free to contact our Call Center at 1 800 538 1880 for further information. Thank you for your continued interest in our Collections.