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Please print and mail this completed form to P.O. Box 1232, Avon, CT 06001
or FAX credit card orders to 1-860-658-1850. Telephone: 1-800-45-CHEST.

Name:____________________________________ Date of order:________ Street Address:________________________________________________ City:__________________________ State: __________ZIP:____________ Country:_____ Phone Number: ________________ Hours: ______________

*	QTY.	Item Ordered xxxxx	Chest Color	Letter Color	Unit Price	$ TOTAL
1	.		.	.		.
2	.		.	.		.
3	.		.	.		.
					Subtotal	.
Add $1.50 per character after 20						.
GOLD lettering: Add $12.00						.
Toy Chest option: Add $28 for Slo-Close (TM) Anti Slam Lid support & hinges						.
*Connecticut delivery add 6%					Tax*	.
See Shipping Information (below)					Shipping	.
Please make check payable to "Cottage Furniture Ltd." P.O. Box 1232, Avon, CT 06001					Total	.

Credit Card Number:

Print Name:

Expiration Date (mm/yy):    Signature

PERSONALIZATION: (Please print numbers and letters clearly. First 20 characters are free)

FRONT:_________________________________________________________________________

BACK:__________________________________________________________________________

TOP:___________________________________________________________________________

SPECIAL INSTRUCTIONS:___________________________________________________________

_______________________________________________________________________________