Blinds USA Inc Order Form / Request Form


 Window Blind Replacement Parts
Components and Mounting Hardware

 
We Discount Combined Shipping

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Order / Request Form

 

Use the form below to:

Specify your request in the Message box at the bottom of the form.

Submit up to 3-items per form, if more space is needed simply submit another form, the Name and Email address must match that of the first, the shipping address can be marked as "Same". Once your request has been received you will receive an invoice by return email within 24 hours or less.

Printable Form

 

  

Order Form
 ( * Required Fields )

Full Name: *
Shipping Address: *
Phone Number: *
Email Address: *
Form of Payment: * Money Order
Cashier Check
Personal Check
Other (Specify in Message box below)
Item (Name): *
Item #: *
Quantity: *

Quantity Contains: *

 Single Item (1)
Pair / Set
Package of (10)
Other (Specify in Message box below)
Item (Name):
Item #:
Quantity:

Quantity Contains:

 Single Item (1)
Pair / Set
Package of (10)
Other (Specify in Message box below)
Item (Name):
Item #:
Quantity:

Quantity Contains:

Single Item (1)
Pair / Set
Package of (10)
Other (Specify in Message box below)
Message:
Submit another page:
Yes
No
       
 
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