Retail customers who wish to purchase Quartet, please print out the following form, fill out the necessary information, and send it along with a check or money order to:

HAGEN-RENAKER, INC.
P.O. BOX 427
SAN DIMAS, CA 91773

THE COST OF THE PIECE IS $100. THIS INCLUDES SHIPPING AND HANDLING.

California residents - please add 7.25% Sales Tax ($7.25) for a total cost of $107.25. Customers in foreign countries must supply a credit card number (Visa, MasterCharge, or American Express), and we will ship via UPS and charge the shipping charges and the cost of the piece to your credit card).

SPECIFY COLOR: WHITE __ BAY __ CHESTNUT __ GRAY __

NAME __________________________________________________________

STREET ________________________________________________________

CITY __________________________________________________________

STATE _________ ZIP _____________ COUNTRY _____________________

PAYMENT METHOD:

CK __________

CREDIT CARD ________________________________

NUMBER _____________________________________

EXP DATE ___________

SIGNATURE _____________________________________________________