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Upholstery Order Form


You have ordered an item with the option for COM (Customers-Own-Material).

Before completing this form, please contact one of our Product Specialists by e-mail or phone at 1•877•78bella to determine the amount of yardage you will need for your particular fabric.

Pease review our COM Guidelines before consulting with our Specialists. It will give you insight and knowledge of some basic terminology so you will better understand the options available on your particular piece.

Once you know how much fabric you need; please complete this form, print it out and then send it in with your fabric. If you have any questions about this form please let us know.

1) Please indicate which item you are ordering from the product information pages:
I am ordering item number:
with a finish,
to be covered in my own material, which I am enclosing.
2) Please initial one of the boxes below:
I have enclosed the specified amount of fabric yardage and trim (if any) as advised by my Product Consultant. This amount is as follows:
**Fabric needs to be prewashed if it will be used for a slipcover you intend to machine launder.
My fabric is being sent separately, labeled with my name and address.
3) My 'Rough Draft' is enclosed with fabric samples attached. Please consult our Rough Draft description for details.
Please complete if applicable:

Place the design/pattern in the following manner:
(e.g.) Center the pattern on the sofa back, etc.

4) Please provide all of the following information. All fields are required:

Ship my order to the following name and address:
(Sorry, no P.O. Boxes.)

Address 1

Address 2

Zip Code
E-mail Address

Daytime phone

Evening phone

5) Please indicate your method of payment.
Be sure to include Extra Charges for COM options and Shipping as advised by your Product Specialist.

Item Base Price:
units @   $ each


Extra COM Fabrication Charges

Tax (5% for Indiana residents)


Delivery Charge Total
Please include additional shipping costs as advised by your Designer.





Charge: Check the card type and fill in all blanks.

Visa    Discover    MasterCard    American Express

Account #

Expiration Date


Cardholder's Signature:


(As it appears
on the card)
Billing Address 1

2nd Address Line
(if applicable)


Daytime phone

Evening phone

Check or Money Order Enclosed: Make check payable to
Bella Interiors. Sorry, no CODs or cash. Orders paid by check
will be held until check clears.
6) I request that Bella Interiors follow the above instructions.
I have read this information packet carefully and understand
that because this is a customized order, changes or cancellations
are not possible once production has begun. I recognize that
the delivery of my COM order is based upon when Bella
receives the appropriate yardage from me. Finally, I acknowledge
that COM items are not returnable for refund or exchange.

7) When complete, please mail this order form; your 'rough draft' with swatches; and, your material to the following address:

Bella Interiors
Attn.: COM Department
4123 South Bend Avenue
South Bend, Indiana 46637

We recommend that you send your fabric via UPS insured mail.

Please remember to staple small 1" swatches of your material, right side up, to your 'rough draft'.