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Rare Tiffany Style Lamps
Printable Order Form

  To Print this form, click the PRINT button on your browser (Requires Printer). 

  Web:  www.RareTiffanyStyleLamps.com             Mail: Rare Household Goods, LLC  
   Email:  orders@RareTiffanyStyleLamps.com                  P.O. Box 275

   Phone:  1-866-331-7273                                                Fremont, CA 94537-0275

               M - F;    9 AM - 5 PM  PST                        Fax:  510-505-9157
  Please accept order Delivery Time 5-7 Business Days for:

Description

Item Code

 QTY

Unit Price

Total 

  1. #   $ $
  2. #   $ $
  3. #   $ $
  4. #   $ $
  5. #   $ $

California Sales Tax 8.25% (If applicable):

$

  Sub-Total:

 $

  SHIPPING:
 (Please call 1-866-331-7273 or send email to Orders Dept for shipping fee)

$

  TOTAL (Charge Amount):

 $
Ship To Address:
  Name:
  Street ( No P.O. Box ):
  City:                                                                                      State:                   Zip:

If you select to pay by credit card, please complete the following information.

  Cardholder Name: 
  Card Type: Visa, MC, Discover, Amex (circle one)      Credit Card No:

  Card Verification Code:
  Expiration Date:          /           (MM/YY)   Signature:
  Telephone: (         )            -   E-Mail:
Bill to Address (if different from Ship to Address):
  Name:
  Street:
  City:                                                                                      State:                   Zip:

Thank You for Your Order!