RollerShade Order Form      
Navigation: use the Tab key to switch fields, click on the Submit button when you are finished       Today's Date:
      Date Req'd:
  PO #:
  Sidemark:
216-351-3283 ** 800-468-5108   Check all information carefully. Once started, custom orders can not be cancelled.  
Acct #:   Routing (select one):      
Bill To:                
Address:   Ship To (if different):  
City, State, Zip   Address:  
Tele #:   City, State, Zip  
Select One:             C= Cassette  
Hemstyle           Reverse Controls: CL-Clutch L, CR-Clutch R V=Val If Deco Hem  
Line Quan- P-Plain, D-Deco Fabric Fabric     IM or Roll S-Spring, NC-Cordless (LW only) or blank Specify Trim Room
  tity Specify Deco # Style # Name / Color Width Length OM Y or N M-Motorized/Battery options = stnd Style & Color # Tag
A
B
C
D
E
F
G
H
I
J
K
L
M
N
Line#   List Special Instructions                  
Enter Fax #, E-mail address or None to receive Confirmation #.
  Golden Window Fashions
  2500 Brookpark Road  
  Cleveland, Ohio 44134
    Refer to Graber by Golden Price Binder for all specifications & limitations       Fax 216-351-3386 ** 800-358-5108