Regency House Importers of Fine Furniture

Memo Loan Sample Order Form

Name: *
RHI Acct #: * 
Company: *
Street: *
2nd Address Line:
 
Your P.O. #:
 
City:*
State: * Zip:*
Country:
Telephone: *
Fax:
E-Mail: *
Today's Date: *
Specifier (Contract Accounts):

Memo Cutting Tearsheet

Item Number* Description Color

Ship To:*
Attn:
  
Address:
  
     City, State, Zip:
 
Sidemark:
  
Ship Via:
  
 

 

* indicates required field.

 

Thank you for your sample order. Please mail or fax completed form. Address: Regency House Imports, PO Box 883814, San Francisco, 94188-3814 Fax: 650-345-7824

 

 

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