Ford's Theatre Chair Order Form Revised For Feb 3
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Receipt # ______
Shipping Costs 1= $110 2= $220 3= $330
Ford’s Theatre Wood Chair Order Form
4 = $440
$50 per Chair Shipping is $110 per chair at $ 50
Total # Requested
Name:
Price
+
Shipping
=
.
Total to be paid
_______________________________________________________________________________
Billing Address:
_______________________________________________________________________________
City/State/Zip:
_______________________________________________________________________________
Email:
_______________________________________________________________________________
Daytime Phone__________________________________
Credit Card
AMEX MC VISA DISC
Alternate Phone______________________________
__________________________________________________________________________ Number
Expiration
Name as It Appears on the Card____________________________________________________________________ Person picking up (if different than above) ___________________________________________________ Mail your completed form and payment to:
Preference for obtaining the chair:
Ms. Megan Kuhn, Campaign Associate
□ PICK-UP CHAIRS at a later date – you will be contacted as to date of pick-up
Ford’s Theatre Society 514 Tenth Street, NW
□ SHIPPED FOR $110 PER CHAIR – you will be contacted as to when chair will ship
Washington, DC 20004 p. 202-434-9527 / f. 202-783-5718 / e. [email protected]
Shipping Address (If different from billing address): ________________________________________________________________________________________ Name/ Attention
Company
__________________________________________________________________________________________________ Street
City
State
(If home address, Signature release?) Date Ordered ____________________________________Taken By: ________________________________ Archtics: ____________________________________ By: _______________________________________ Account # ____________________________________
Zip
Shipping Costs 1= $110 2= $220 3= $330
Ford’s Theatre Wood Chair Order Form
4 = $440
$50 per Chair Shipping is $110 per chair at $ 50
Total # Requested
Name:
Price
+
Shipping
=
.
Total to be paid
_______________________________________________________________________________
Billing Address:
_______________________________________________________________________________
City/State/Zip:
_______________________________________________________________________________
Email:
_______________________________________________________________________________
Daytime Phone__________________________________
Credit Card
AMEX MC VISA DISC
Alternate Phone______________________________
__________________________________________________________________________ Number
Expiration
Name as It Appears on the Card____________________________________________________________________ Person picking up (if different than above) ___________________________________________________ Mail your completed form and payment to:
Preference for obtaining the chair:
Ms. Megan Kuhn, Campaign Associate
□ PICK-UP CHAIRS at a later date – you will be contacted as to date of pick-up
Ford’s Theatre Society 514 Tenth Street, NW
□ SHIPPED FOR $110 PER CHAIR – you will be contacted as to when chair will ship
Washington, DC 20004 p. 202-434-9527 / f. 202-783-5718 / e. [email protected]
Shipping Address (If different from billing address): ________________________________________________________________________________________ Name/ Attention
Company
__________________________________________________________________________________________________ Street
City
State
(If home address, Signature release?) Date Ordered ____________________________________Taken By: ________________________________ Archtics: ____________________________________ By: _______________________________________ Account # ____________________________________
Zip
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