Order Form

To complete the order form print, then mail to White Pavilion, P.O. Box 8842, Gallatin TN, 37066 or
fax to 615-230-5776.

Please view our Size Chart and Shipping and Ordering pages for helpful information.

We ship UPS as a rule.*

Ship to: Payment:
Name: Check ( ) Money Order ( )
Street/Box: Credit Card
City/State: MC ( ) Visa ( ) Discover ( )
Zip: Card#:
Phone: Expiration:
Email:

Signature:
 
Item# Item Name Size Color Quantity Total
           
           
           
           
           
           
           
           
           
           
Shipping Rates
up to $50 = $4
$51 to $100 = $6
$101 t0 $150 = $8
$151 to $200 = $9
Over $200 call
for quote 		Special Instructions Handling: $4.00
Shipping:  
Total:  
 
*If you prefer the U.S. Postal Service, or must have delivery to a P.O. box, be aware that the U.S.P.S. does not guarantee delivery or track stray parcels on any but express (overnight) service.  Therefore, we cannot be responsible for parcels lost by the U.S.P.S. unless they have been sent via Express Mail.