| LA CHAIRCOVERS & LINENS Phone: (310) 294-3838 • Fax: (310) 855 3617 |
| Print and Fax or e-Mail your Orders |
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| Method of payment: |
| ___ Money Order |
| ___ VISA/MASTERCARD AMEX/DISCOVERY |
| Customers Information: |
| Name: |
| ______________________________ |
| Address : |
| ______________________________ |
| ______________________________ |
| Phone: |
| _______________________ |
| Fax: |
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| ORDER FORM |
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| TYPE OF FABRIC |
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