Person's Name:	 	___________________________________________

Mailing Address: 	___________________________________________

City and State:	 	___________________________________________

eMail Address:	 	___________________________________________

Telephone Number: 	___________________________________________

Mobile Phone Number: 	___________________________________________



Rug Number: 		__________

Rug Name:		___________________________________________

Rug Number: 		__________

Rug Name:		___________________________________________

Rug Number: 		__________

Rug Name:		___________________________________________

Rug Number: 		__________

Rug Name:		___________________________________________

Rug Number: 		__________

Rug Name:		___________________________________________

Rug Number: 		__________

Rug Name:		___________________________________________

Rug Number: 		__________

Rug Name:		___________________________________________

Rug Number: 		__________

Rug Name:		___________________________________________


If you are ordering less than 5 rugs, please use the  standard order form.

Amount Included:	$16.95 each	x _________	______________

Please include an additional $5 for shipping outside United States.

Mail to Robert Andrews - 4140 N Central Ave., Suite 2002, Phoenix, AZ 85012