Roller Blind Order Form - DOC

							                                                                                              PrivacySheer ™ Order Form
Dealer Code                                        Consumer                                                             Date

Dealer Name                                        Address                                                              PO

Address                                                                                                                 Tag

                                                   City                                                                 Dealer Sales
                                                                                                                        Person
City                                               Phone                                                                Jackson Ref #

Phone



Qty        Width       Length   Pattern & Colour           Pvc             Rail               Draw     Control   Mount         Bottom     Valance                        Valance      Price
                                                           Icicle colour                                                                                                 End Return
                                                                           1 Laser Guard      Right    Right     Proj          Velcro     None
                                                                           2 n/a                                                          Standard                       6"
                                                                           3 n/a              Left     Left                               Standard Pouff                 6"
                                                                           4 Guide & weight   Centre             Ceiling       Floating
                                                                           5 Guide & Pulley                                    Hem        Executive                      6"
                                                                           6 n/a                                                          Executive Pouff                6"
                                                                                                                                          Double Executive               7 / 6.25"
                                                                                                                                          Double Exec Pouff
                                                                                                                                          (specify Trim colour on exec   Other
                                                                                                                                          and double exec)




Special Instructions