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MAIL-IN ORDER PAGE Date:________________ PLEASE PRINT Your Name:___________________________________________________ Ship to Address: _______________________________________________ City, State, Zip Code:____________________________________________ Telephone Number (for order processing): ____________________________ email address:__________________________ Payment Method: p Faxing Check p Mailing Check/M.O.
PLEASE MAKE CHECKS PAYABLE TO HOMEPLACE GROUP, INC.
TO PLACE YOUR ORDER, PLEASE MAIL THIS ORDER TO:
Adjustamatt.com Homeplace Parts P.O. Box 7106, High Point, NC 27264 Please email us if you have any questions.
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