Refined Rustics printable order form

Please fill and send the order form below. We will contact you shortly to confirm your order.
Since most pieces are made to order, please allow 3-4 weeks before shipping.

Specializing in unique handcrafted furniture. From the Adirondacks to you.	Refined Rustics 526 Canada St Lake George, NY 12845 Fax: 518-798-1413

Name:	_______________________
Phone:	_______________________	Fax:	_______________________
Email address:	_______________________

Shipping address: _______________________ _______________________ _______________________ _______________________	Billing address (if different): _______________________ _______________________ _______________________ _______________________

	Product	Unit Price		Total
___	Mug Shelf	$845		___________
___	Collectible Shelf	$1265		___________
___	Foyer/Mantel piece	$2495		___________
___	Coffee Table	$1295		___________
			Merchandise Total:	___________
			NYS Sales Tax (if applicable):	___________
			Shipping and Handling:	___________
			Total:	___________

Payment method		MC/Visa _______________________ Exp ___ /___ (mm/yy)
		Check

Special instructions or notes	______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________