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  Phone Orders: (201) 828-9403
Fax Orders: (646) 349-1703

Ship to:

Name: _________________________
Company: ______________________
Address: _______________________
City: ___________ Postal Code: ___________
Phone: ________________________

Ordered by:
Is this a gift? Yes No

Name: ________________________
Company: _____________________
Address: ______________________
City: ____________ Postal Code: _________
Phone: (work)__________________ (home) __________________
Please provide both numbers so we may contact you with any questions about your order.

Item Qty Description Unit price Total
HSCB   All cloth black only $ 1,395  
HSVB   Leatherette (simulated leather, black)
$ 1,395
HSVL   Leather face (black)
$ 1,895
HSAL   All leather (black)
$ 2,195
Lumbar   Inflatable lumbar support
$ 149
Logo   Embossed or embroidered company logo
Merchandise Total  
Shipping (Canada only) $ 180
Handling $ 35
Home Delivery (any house/Apt.) $ 50
Total Amount USD$  

Your signature of approval for this order: ____________________________

Payment: Total $___________
Personal Cheque
Official Bank Cheque
Company Cheque
Money Order
Check here for credit card orders and fax this form to us directly for a call back.

We're sorry, but due to the size and weight if the items we are unable to use the usual courier's such as UPS, Fed-Ex, etc. Shipments to home addresses require an additional charge of $50 no exceptions. Shipments to a business location do not. Destinations such as Alaska, Hawaii and Puerto Rico require additional shipping charges.

Seats, LLC
PO Box 141699, Coral Gables, FL 33114
Tel: (201) 828-9403
Fax: (646) 349-1703

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