Retro@Home, 3811 San Pablo Ave., Emeryville CA 94608, USA

Ph: 510.658.6600 • Fax: 510.568.0218

Order Form

  

Please print out this form, fill in the appropriate fields, and fax it or mail it to us. You may also email this form's information to sales@retroathome.com. We always advise faxing or calling in any credit card numbers. In stock items ship within three business days of order confirmation. Out of stock items may take 4-6 weeks for delivery. MC or Visa accepted.

Bill To:

Ship To:

Name:

Name:

Address:

Address:

City, State, Zip:

City, State, Zip:

Telephone No:

Message:

Email address:

Name as it appears on CC:

Visa or MC #, Exp Date:

Zip code, as it appears on the credit card statement:

Item number:

Finish/Color:

Quantity:

Price:

Subtotal:

Total:

Merchandise Total:

 

Shipping Charge within 48 contiguous states, 10% of merchandise total:

 

California State Sales Tax 8.75%, ONLY if ordering items in CA:

 

Order Total:

 

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