Couch Caddy - Your Home Entertainment Center

Mail Order Form

Print This Form Before Using
(Money Orders and Cashier's Checks Only - NO PERSONAL CHECKS PLEASE)
ORDER DATE: __________________

BILLING ADDRESS: SHIPPING ADDRESS:

Name: Name:

Address: Address:

City/State/Zip: City/State/Zip:

Phone #: Phone #:

E-Mail: [ ] Check here if same as billing address

Qty

Description

Item #

Price

Total

Sub-Total:

(if applicable) S/H:

GRAND TOTAL:

Make Payable To:

DAN MCBRIDE
21851 N Woodman Drive
Paulden AZ 86334-4429
1 (928) 636-1635
E-mail Us Terms of Use:

» S/H has already been added to Couch Caddy prices
» Special orders or quantities - we will quote for S/H in advance
» Payments are "due in advance" before we ship any products
» No Refunds or Returns on custom orders
» Custom Orders: Allow approx. 2-3 weeks for delivery

Comments or Special Instructions:

Please visit us again at www.couch-caddy.com