Call Us For A Free Sample 713-255-9211 or 800-929-9211 M-F 7am to 4:30pm
Instructions: Review our How
to Measure page, Print this Form, Fill it out Completely,
Fax it to 713-227-0808 or Mail to 3900 Polk St., Houston, Texas 77023
Call our Customer Service Department for Assistance
| Quantity | Type of Blind Vertical, Wood, Micro, Symphony Pleated Shades |
Vertical & Pleated Pattern Name |
Insert Groovers for Verticals |
Color Name & Number |
Type of Mount Circle One |
|
Length |
Wand Circle |
Cord Circle |
Vertical Blind Stak Circle |
Valance Circle |
Line Total |
|
|
Yes No |
Inside Outside |
Left Right |
Left Right |
Left Split Right |
Yes No |
$ | |||||
| Yes No |
Inside Outside |
Left Right |
Left Right |
Left Split Right |
Yes No |
$ | ||||||
| Yes No |
Inside Outside |
Left Right |
Left Right |
Left Split Right |
Yes No |
$ | ||||||
| Yes No |
Inside Outside |
Left Right |
Left Right |
Left Split Right |
Yes No |
$ | ||||||
| Yes No |
Inside Outside |
Left Right |
Left Right |
Left Split Right |
Yes No |
$ |
| SubTotal........$ |
| Texas Res Add 8.25% |
| Freight* |
| Total Due |
*Freight: Up to 100" in Width..."No Charge" Over 100" in Width...$50 Charge.
Credit Card/Payment Information
Note: Because this is a Custom made product, your credit card will be charged at the time your order is placed with Custom Drapery Blinds & Carpet.
Please indicate method of payment: Check*____, Visa____, Master Card____, Discover____, American Express____
*When paying by check, your order will be processed when we receive your payment and your check is approved by Telecheck. Also note that all checks must have Driver's License Number, State and Date of Birth.
Purchaser's Credit Card Number_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Exp Date_ _/_ _
Signature____________________________
Valid only with full signature of Cardholder
|
Important
____________________________ _____________ |