| For photos, refer to the
English page when making choices for this form. Call
(715)455-1652 for custom color or fabric information. |
| English Seat Saver
Cushion |
Quantity |
Item Price |
Total Price |
| _______ |
$38.00 |
$_________ |
| Top Fabric Choices - Circle or highlight color choice |
Faux
Leopard Skin1.Blk/Brn/Crm
multi
|
Faux Butter Suede (fuzzy) 1.Black
2.Dark
Brown 3.Brown
4.Gold
(pale)
|
| Polar Fleece Horse Head Print 1.Gold
multi (more palominos) |
| Polar Fleece Tie Dye 1.Bright
multi (red, pink, yellow, blue, green, gold, purple) |
| Stretch Suede 1. Black |
| Stretch Suede Check 1. Black on Black |
Special Instructions:
How did you find us? |
Sub Total |
$_________ |
| Wisconsin Sales Tax (Wisconsin residents only) |
5.5% |
$_________ |
| Shipping up to $60 |
$5.95 |
$_________ |
| Shipping $60 to $120 |
$7.95 |
$_________ |
| Shipping over $120 |
Free |
$_________ |
| Total Amount Due |
$_________ |
Credit Card Type (circle one): Visa, MC, AmEx,
Disc
Credit Card # __________-__________-__________-__________
Expiration Date__________ Security Code (3 digits on back)__________(or
4 digits on front by signature)______________
Name on Card
|
|
|
|
Name ___________________________________________________Date_________________________ |
|
Address ______________________________________________________________________________ |
|
City________________________________________ State ________ Zip
Code _________ |
| |
| Phone_________________________Email_________________________________________ |
mail: byGayle
N14397 380th Street
Ridgeland, WI 54763 USA
We will accept your payment with VISA, Master Card, American Express,
or Discover by phone or on the WEB, check, money order or
credit card by mail. Email:gayle@bygayle.com Phone:1(715)455-1652 |