Please indicate below the design and size in which you are interested. If we have a stocking dealer in your area, we will refer you to that dealer. If he does not have that particular carpet in stock, he can order it in for you. If we do not have a dealer near you, we will send you a good photo of the rug, and a list of the sizes available which are closest to your specified size, with pricing and shipping information. Carpet Design Name Approximate Size(s) Desired 3 x 5   4 x 6   6 x 9 8 x 10   9 x 12 Your Name Mailing Address (no P.O. boxes, please) City State Zip Code Telephone Fax Email     Completion of this form entitles you to a $100.00 gift certificate against any purchase of $1000.00 or more or a $50.00 gift certificate against any purchase of $500.00-$999.00.

107 West Main St., Charlottesville, Virginia 22902 Telephone 001-434-971-8822   Fax 001-434-971-9346