ORDER FORM
Print this form from your computer. Use this form only if your table is rectangular, square or round (circle) in shape and you already know which colors you want for your vinyl tops and felt bottoms

Send to:     EMPIRE TABLE PADS                       9540 West Caravan Path    Crystal River, FL 34428   Phone: 1-352-220-8920     Fax: 1-352-220-8920  Please Print:  Your Name:__________________________  Address:____________________________  City, State, Zip:_______________________  E-Mail:_____________________________  Telephone:__________________________ MEASUREMENTS: Measure only the flat surface of your table. Be sure to use a metal tape when measuring. Cloth and plastic measuring tapes will stretch and result in inaccurate measurements. Give measurements in inches. SQUARE OR RECTANGULAR TABLE ROUND TABLE TABLE LEAFS Length: ________ Width:________ How Many? ____ Diameter:_______ How Many? ____ Length____ Width____ How Many? ____ COLORS: Circle your choice of colors from the selection below: VINYL TOPS è Blonde   Mahogany   Brownstone   Sand   Ebony  Cherrywood   Winter-White   Walnut   Fruitwood   Burgundy   Hazel   Spice   Butterscotch   Gravel   Oak   Soapstone   Brandy   Elm   Mimosa   Doeskin   Pecan   Hawthorne   Coffee FELT BOTTOMS è Leaf   Chocolate   Tan   Pebble   Green Stone   Copper   Toast   Maroon PRICE STRUCTURE: PADS AND LEAFS PRICES SHIPPING AND HANDLING   Table up to 72" without leafs.....................$129.00   Table 1 leaf ...............................................$155.00   Table 2 leafs up to 95 inches .....................$175.00   Table 3 leafs up to 95 inches......................$195.00   Table incl. leafs  95 to 120 inches .............$210.00   Table width 47"- 60" add.............................$20.00   Buffet or Server............................................$79.00   Circle or Square table up to 46 inches........$149.00   Circle or Square table 46 to 60 inches........$179.00   Leaf Storage Bag .........................................$19.95   Eastern .............................$22.00   Central .............................$23.00   Mountain...........................$29.00   Pacific...............................$32.00   Alaska and Hawaii .Call for Rate METHOD OF PAYMENT: Please check one: Money Order or Personal Check:___      Visa:____     Mastercard:____ Credit Card Number: _______________________________ Exp. Date: ______________ Customer's Signature:_______________________________ Order Date: _____________