3D CHESS ODER FORM

Print and complete this form and return it with your check or money order to:

312 Bell Avenue

Sheboygan WI 53083

Sold to:			Ship to (if different than Sold to):
Name: ________________________			Name: ____________________________
Address: ______________________			Address: __________________________
City: _________________________			City: _____________________________
State: _____		Zip: _____________	State: _____		Zip: __________________
Phone: _______________________			Phone: ____________________________

Quantity	Chessboard Description			Chess Piece Color		Price each		Extended Amount (Quantity X Price)
	12 x 12 Walnut/Maple			2-7/8" Wood		$139.00
	12 x 12 Cherry/Maple			2-7/8" Wood		$139.00
	14 x 14 Walnut/Maple			Wood Felted		$159.00
	14 x 14 Padouk/Maple			Russian Style Black		$159.00
Sub total: ____________
Wisconsin Residents add 5% Sales Tax: ____________
Shipping/handling Included*: _______0.00_
Total Enclosed:							$

* Please contact 3D Chess for shipping costs for orders outside the continental USA.

Allow 2 to 5 weeks for delivery.

Thank you for your order!

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