Area Rug & Item Order Form
(if you prefer not to order online or by phone)

Fax or Mail this order form to:

Waxman’s Carpet & Rug Warehouse    
24601 Lorain Road
North Olmsted, Ohio 44070

FAX: (440) 734-6117

Phone Orders: (440) 734-7060
Toll Free Phone Number: 1-800-334-8397

Name _____________________________________________________

Street Address ______________________________________________

City _____________________ State _______________ Zip __________

Phone # ( ______ ) _________________ FAX # ( ______ ) _________________

E-mail Address ____________________________________________________

Method of Payment

__ MC    __ Visa    __ Discover    __ AMEX    __ Check     __ Money Order

                            [ Credit Card Number ]                                                                      

Expiration Date   __ __     __ __
                            Month      Year                     

Signature _________________________________________

Please call 1-800-334-8397 if you would like to check on the availability of the item(s) you want to order.

                                                                              Sub-Total __________

                                              Ohio residents add 8.00% sales tax __________

                                                                                        Total __________

Print from your web browser this form, and then fax or mail it.