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