Regency House Importers of Fine Furniture

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):

* Regular Order Reserve Cut For Approval Check Stock

Item Number* Description Color Quantity*

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


To pay for your order by credit card please provide the following information:.
  Master Card Visa American Express  
Card #:
  
Expiration Date:
  
Name:
 (as it appears on the card)  
Notes:
  
* indicates required field.
 

 

 

 

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

 

You will receive an acknowledgement with your reference number via email .

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