P.O. Box 129
Maple Park, IL 60151

 PHONE: (815) 895-4247
FAX: (815) 899-7546
EMAIL: customerservice@tailwindfurniture.com

Bill To:

   

Ship To:

 
Name:   Name:
Address:   Address:
     
City, State Zip:   City, State Zip:
Phone Number:   Phone Number:
 My Shipping address is the same as my billing address:

QUANTITY

PRODUCT

DESCRIPTION

COLOR

UNIT PRICE

TOTAL PRICE
  Sub Total
  IL Customers Check Here (6.25% Tax)
  Shipping/Freight
  Total
 
PAYMENT METHOD:

Check Enclosed:
Visa: MasterCard:

Card No. Exp. Date

Security Code (last 3 digits in signature box):

Name on Card:
Address for Credit Card:

 

Signature_________________________________________________