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Type of Customer: --select one-- Retail Contract  Contract:   --select one-- Architect Dealer Designer End User Specifier E-commerce Sales Representative   Retail:   --select one-- Casual Furniture Department Store Contemporary Furniture Traditional Furniture Catalogue E-commerce Sales Representative  • Last Name:    • State/Providence:   AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VI VT WA WI -- AB BC MB NB NF NT NS ON PE QC SK YT  Fax:   Type of Business: • Company Name: • First Name: Title: • Address:   • City: • Zip/Postal Code: • Country: • E-Mail: • Phone:

• Date(mm/dd/yy): Ship Via ---NONE--- Collect Prepaid & Add Third Party(specify billing name, address and telephone) Other (note in special instructions area) • Your Reference: • Ship Via: Special Instructions:

• Please include an estimated freight cost:  Ship to:  • City:  • State/Providence:   AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VI VT WA WI -- AB BC MB NB NF NT NS ON PE QC SK YT • Zip/Postal Code:   Item No. Color Qty Unit Price (US$) Extended Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area) Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area) Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area) Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area) Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area) Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area) Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area) Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area) Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area) Item No. ---NONE--- 105 116 118 129 130 158 189 190 192 212 267 268 271 272 320 324 325 326 330 340 341 350 354 355 356 357 358 359 360 361 362 370 371 372 373 375 380 381 382 383 384 385 386 392 393 398 539 650 800 801 802 803 804 805 807 851 852 853 900 901 902 903 904 905 906 907 909 910 924 945 953 954 955 956 957 958 965 966 1516 3400 3401 3402 3403 3405 3410 3411 3460 3461 U601 U701 U801 M907 M909 M911 MA55 MA58 MA65 MA70 MA75 MA85 MA100 MW55 MW65 MW70 MW75 MW85 MW100 Color ---NONE--- White Antique Blue Green Black Aluminum Antique Iron Cherry Beech Yellow Hunter Wine Natural Plum Red Navy Brown Orange Light Blue Light Green Butter Off White Other (please specify in special instruction area)       Total: * By pressing the "I agree" button, you agree to the Terms and Conditions of Sale.