Shipping Questionnaire

 
 
REFERENCE # __________________FOR OFFICE USE ONLY
 
 

 
 

Enter your email address
Your first name
Your last name
Your telephone number including area code
Enter your complete street address where the chair(s) will be shipped
Your city
Your state or province
Your country
Your zip / postal code or other
Is this a business purchasing the chair or is it a private purchase? Business Private
Will the chair (s) be shipped to a business address or a personal address? Business Private
Additional comments or questions