POW-MIA CHAIR OF HONOR ORDER FORM

POW-MIA CHAIR OF HONOR

ORDER FORM

Required information is indicated in red *.

POW-MIA CHAIR OF HONOR |

Lead Time: 4 - 6 weeks

Chair $200 + $200 Shipping

Organization Name*

Company | Organization purchasing the chair(s).

Contact Person*

Title

Email*

Website

Website of Purchasing organization or Installation Venue

Contact Phone Number*

Contact Mobile Number

Street Address*

Ship to Street Address

Mailing Address

PO Box

City*

Ship to City

State*

Ship to State

Zip Code*

Ship to Zip Code

Venue Name of Chair Installation*

Quantity of Fusion Chairs*

Please select payment type.*

Select

PO Number*

If purchasing with a PO, please enter the PO number and attach PO to this order.

File Upload

Please upload PO, Tax Exempt forms

Drag and drop files here or

Credit Card Payment Form*

If purchasing on a credit card, please enter your email address to receive a form to enter your information for payment.

Need By Date*

Standard lead time is 4 - 6 weeks.

Order Notes

Send me a copy of my responses