Order Form Pride Casual Line Lift Chairs

Need help ordering?

800 689 0030

Pride CASUAL LINE Lift Chairs Order Form

If you would like to Pay by check, click here.

(NOTE: Please check Box to add to Total at bottom.)

1) Select Lift Chair Model (Check Box)

	Pride CL-10 Lift Chair (NOTE: Fabric colors only offered in Blue, Dusty Rose, Mocha and New Chestnut Vinyl)	............. $472.00

	Pride CL-15 Lift Chair (NOTE: Fabric colors only offered in Blue, Dusty Rose, Mocha and New Chestnut Vinyl)	............. $556.00

	Pride CL-20 Lift Chair	............. $528.00

	Pride CL-30 Lift Chair	............. $584.00

2) Select Fabric (Check Box)

	Blue
	Mocha
	Dusty Rose
	New Jade
	Oatmeal
	New Sapphire
	New Chestnut Vinyl`1`

3) Select Additional Options (Check Box)

	Standard Heat and Massage	........$ 150.00
	Extra Head and Arm Covers	........$ 45.00
	Left Hand Control	........$ 30.00
	In-Home Setup (optional)	........$ 125.00
	1 Year In-Home Warranty	........$ 25.00

4) Shipping

Free Shipping

.............. Free

Your Total is:

Note: To remove an item, click the check box again.

Shipping Address:

Name

Address

City State

Zip Code Phone#

E-mail Address

Billing Address:

Same As Above

Name

Address

City State

Zip Code Phone#

E-mail Address

Additional Comments:

Payment Information:

Card # Security Card Code Expiration Date

Please allow at least 2 Business days to request a tracking number.

In "sending" this order, you are placing a firm order and authorizing Scooterville to charge your credit card the total amount of this purchase. If there is a problem with the order, please Contact Us.

Thank you for your order.

Toll Free 1 800 689 0030