Germain Mantels

1943 Hermance Road, Galway, New York 12074

518.882.9697 phone/fax, M-F, 9am-6pm EST.

Email us Anytime at:

	ORDER REQUEST

Please only use this form for custom orders, to order standard dimension units please view our product line.

We will contact you to confirm your order details.

Account Name

Full Name

(required)

Billing Address

Address

(required)

City

(required)

State

County

Zip Code

(required)

Shipping Address

Address

City

State

County

Zip Code

Contact Person

Best time to contact

Phone #

(required)

Fax #

Email #

(required)

Order Date

PO#/Job Name

Requested Delivery Date

Quantity

Item

(STANDARD UNITS CAN USUALLY BE SHIPPED IN 4-6 WEEKS)

Wood Type

Poplar
Red Oak
Other

Standard Or Arched Headboard

Standard Or Bowed Shelf

Standard Or Flush Hearth Leg Length

Standard Dimension Unit

Custom Dimension Request

The Measuring page can help you determine your dimension needs, or you can fill it in so we can help you.

GERMAIN MANTELS 1943 Hermance Road, Galway New York 12074
EMAIL US ANYTIME AT: info@germainmantels.com - PHONE/FAX: 518.882.9697 Monday-Friday, 9AM-6PM Eastern