Fax/Mail Manual 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: ______________________

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":

__ Purchase order:_____________________________

__ Check or money order. Checks must be US bank checks.

__ 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: ________________________________________________

Make check out and mail this order form to following address,
or fax toll free to (866) 827-7747:
     
     Bright Hospitality Inc.
     P.O. Box 374
     Titusville, PA 16354