Braided Rug Order Form | Order Carpet .com

Please fill out and submit this secure order form for your Braided Rugs order. All prices include shipping and handling. If your order is being shipped to Rhode Island, 7% state tax will be added. If you need to order more than 3 variations, please return to this form and order again.

Required fields are marked with (*).

Rug #1
Size:
Color:		Qty:
Rug #2
Size:
Color:		Qty:
Rug #3
Size:
Color:		Qty:
Billing Information
*Name:
*Street address:
Address (cont.):
*City:
*State:
*Zip code:
Work Phone:
*Home Phone:
*E-mail:
Payment Information
Payment type:	Check
Card type:	Visa MasterCard Discover
Card Number:
Expiration date:
Comments:

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