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Outdoor Fabrics / About Us / Our Location / How to Order
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485-17 Broadway • Hicksville, NY 11801
516-932-3838 • 800-645-7560 • Fax 516-932-7347

YOU MAY PRINT OUT THIS FORM FOR FAX OR MAIL

SOLD TO:

ACCOUNT #_______________________________

NAME____________________________________

COMPANY_________________________________

ADDRESS_________________________________

CITY_____________________________________

STATE/ZIP________________________________

PHONE__________________EMAIL_____________

SHIP TO (if different):

ACCOUNT #_______________________________

NAME____________________________________

COMPANY_________________________________

ADDRESS_________________________________

CITY_____________________________________

STATE/ZIP________________________________

PHONE__________________EMAIL_____________

QTY

U/M

PATTERN NAME

Color

UNIT
PRICE

TOTAL
PRICE

5

Yds

Starburst

Tan

10.00

50.00

METHOD OF PAYMENT

____CREDIT CARD (Circle One):

MC • VISA • Discover • AMEX

Account Number:
_ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _

Expiration Date:_______________________________

Signature:____________________________________

____CHECK OR MONEY ORDER ENCLOSED.
Please make payable to: Frank Bella & Co.
485-17 Broadway • Hicksville, NY 11801

Home / Residential / Commercial / Supplies / Naugahyde /
Outdoor Fabrics / About Us / Our Location / How to Order
Order Form / Request Samples / Open an Account