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Store Information

* Order #:	Store #:	Date: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2010
Sales Consultant:		Phone:
Address:		City:	State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Virgin Islands American Samoa Guam	Zip:

Customer Information

Customer Name:	Phone:
Address:	City:	State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Virgin Islands American Samoa Guam	Zip:

Flat Panel Information

Plasma/LCD Model/Size:

Speakers part of display: Yes No

Will speakers be removed? Yes No

Artwork

Categories: Featured ArtistFeatured ArtistHoward BehrensJim Gerald HolehouseNoted Contemporary ArtistsPopular ArtShelly Lawler Print #: --Select the Artwork--

Picture Preview: $

Frame & Liner

Group: Group A Group B Group C Group D

Frame Model:--Select the Frame Model-- Liner Model:--Select the Liner Model--

Artscreen Models & Pricing

$

Description	Model	Group A Frame	Group B Frame	Group C Frame	Group D Frame
		MSRP	MSRP	MSRP	MSRP
42" Surface	01-AS-42	$ 2,850.00	$ 3,167.00	$ 3,483.00	$ 4,108.00
50" Surface	01-AS-50	$ 3,500.00	$ 3,858.00	$ 4,225.00	$ 4,917.00
60" Surface	01-AS-60	$ 4,400.00	$ 4,800.00	$ 5,217.00	$ 6,008.00
42" Recessed	01-ASR-42	$ 3,167.00	$ 3,483.00	$ 3,808.00	$ 4,433.00
50" Recessed	01-ASR-50	$ 3,833.00	$ 4,192.00	$ 4,550.00	$ 5,250.00
60" Recessed	01-ASR-60	$ 4,833.00	$ 5,233.00	$ 5,658.00	$ 6,450.00
If the dispaly is larger then the listed standard sizes choose the text size larger pricing. If larger then 60" add 25% to the 60" price.

Total

I hereby acknowledge and verify that the display size, art selection and frame style have been approved and are final as of this date 20

Total $