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Order Information

Please make your selections below by entering the quantity of items desired for the amount of time desired.

	0-3 mths.	3-6 mths.	6+ mths.
One-Bedroom Houseware Package:
Two-Bedroom Houseware Package:
Three-Bedroom Houseware Package:
20" Television:
25" Television:
VCR:
DVD Player:
Microwave Oven:
Vacuum Cleaner:
Mop:
Asian Package:
Answering Machine:
Additional Telephone:
Sofa Bed Ensemble:
Portable Stereo:
Crib Linens:
Hand Mixer:
Large Ironing Board:
Blender:

Delivery & Set-Up Information

Please provide the full address and date where the delivery is to be made. All of these fields (with the exception of "Apt.") are required.

Delivery Address:	Apt. #:

Requested Set-Up Date:

Contact Information

Please provide information so that we may contact you and verify the details of your order. All of these fields (with the exception of "Ext.") are required.

Name:
E-Mail Address:
Phone Number:	Ext.:

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