Fax/Mail Rental Order Form

Billing Info

Name: _______________________________Company:_____________________________________

Address:________________________________City:________________ St:___ Zip:_________

Telephone#: ________________ Fax#: _________________ Email: ______________________


Shipping Info  ___ Check if same as Billing

Name: _______________________________Company:_____________________________________

Address:________________________________City:________________ St:___ Zip:_________

Telephone#: ________________ Fax#: _________________ Email: ______________________

Required Date: __________      Event Date: __________

Contact Phone Number If Different Than Billing Info/Shipping Info: _______________


Order Information

  DESCRIPTION                                                       QTY.    PRICE

1._______________________________________________________________ _______ ________

2._______________________________________________________________ _______ ________

3._______________________________________________________________ _______ ________

Before we place this order, we will call (or email) with the 
total including the exact shipping cost.

Indicate Payment Method with an "X":

__ VISA  __ MasterCard  __ Discover  __ American Express  

      Name as it is on card  _____________________________________________________

      Card #: __________________ Expire MM/YY: _______ 3 or 4 Digit Card ID: _____

      Signature as it is on card: ________________________________________________

Mail this order form to the following address,
or fax toll free to 866-827-7747:
     
     Bright Hospitality Inc.
     P.O. Box 374
     Titusville, PA 16354