GSA Seating Price List - National Office Furniture

A Unit of Kimball International
www.NationalOfficeFurniture.com
1 , Jasper, IN 47549
800.482.1213 Fax 812.481.6166
Date
Participating Dealer
Dealer Contact
Government Agency
Payment Information
Card Holder’s Name
Card Holder’s Phone
Credit Card Number
3 Digit Security Code Exp. Date (mo/yr)
Card Holder’s Signature
❏ Pre Bill Card Immediately
Type of Sale
❏ GSA Schedule Sale (contract GS-2F-)
❏ Non GSA Federal Sale
❏ State/Local Sale (see website for contract information) State of ____
Billing Address
Model Number Description Qty. Unit Price Extended Price
Name
Company
Street
City, State, Zip
Phone
Shipping Address (if different from billing address)
Name
Company
Street
City, State, Zip
Phone
Credit card holder signature required for credit card order and if original information changes.
Credit card orders bill when shipped, see GSAR 552.232.80 (unless noted above).
Modification required with agency signature when change to original order involves product, unit cost, or total cost.
❏ PRODUCT QUOTE ATTACHED TO CREDIT CARD FORM
Fax completed form to Government Sales
at 812.481.6166.
Special Instructions
Product Total
Installation Price
Design Price
Total
Credit Card Order Form