Mail In Order Form

Create-A-Bed®

STANDARD KIT
VERTICAL

STANDARD KIT
HORIZONTAL

Quantity

Quantity
Twin size vertical
_______
Twin size horizontal
_______
Full size vertical
_______
Full size horizontal
_______
Queen size vertical
_______
Queen size horizontal
_______
 
DELUXE KIT
VERTICAL

DELUXE KIT
HORIZONTAL

Quantity

Quantity
Twin size vertical
_______
Twin size horizontal
_______
Full size vertical
_______
Full size horizontal
_______
Queen size vertical
_______
Queen size horizontal
_______

_______ Standard Kit(s) x $249.00 each =

$____________

_______ Deluxe Kit(s) x $299.00 each =

$____________

_______ Bed Light Kit(s) x $79.00 each =

$____________

_______ Bookcase Light Kit(s) x $39.00 each =

$____________

_______ Piston Covers x $10.00 (per pair) =

$____________

TOTAL $____________

Additional shipping charges apply to orders outside the United States. Call or email for more information.
Shipping to Alaska, Hawaii and U.S. Territories is an additional $20.

Billing Address   Shipping Address (If different than billing address)
   

**Note: UPS cannot deliver to a post office box

Name:___________________________________

Street:___________________________________

City:__________________________

State:______ Zip:_______________

Telephone:_______________________________

 

Name:___________________________________

Street:___________________________________

City:__________________________

State:______ Zip:_______________

Telephone:_______________________________


Credit Card: Mastercard Visa American Express Discover  

Exact Name On Card:

Credit Card Number: Expiration Date:

Orders should be mailed to the following address:
C.A.B., Inc.
1800 Taylor Avenue
Louisville, Kentucky 40213