Mailing payment by check or money order? Please PRINT and COMPLETE this form:

Name Of Carpet/Flooring:
Order #: (if available):
Order Type (please check one):
___Area Rug
___ Wall To Wall - For The Entire Room Enter Total # of Square Feet______________

To determine the square footage, multiply the length and the width of the area to be carpeted.

If Ordering Area Rug, Enter Size Here:_______________________
Make Sure The Size You Are Ordering Is Available In Carpet You Have Selected,
(refer to the Carpet Index Table on the previous page).
*Color:_________________________ *Enter Color Selection ONLY If Applicable
Backing Type - Complete For Carpet Orders ONLY (please check one):
____ Action Back
____ Kanga Trac
( Backing Descriptions - See Just Above The Carpet Index Table On The Previous Page)

Shipping Information

Your Name:

Street Address:
City/Town:                                                State:                 Zip Code:
Your E-mail Address:
Home Phone (with area code):                                    Work Phone:
Phone # To Contact When Delivering:
$ Amount Of Carpet/Flooring Purchase_______________________
If You Are Ordering Wall To Wall By The Sq. Ft., Multiply The Length x Width of the area to be carpeted. Then multiply that amount by the square foot dollar amount to determine your total cost.
Game Kits Are Available For The Following Carpets:
( If Ordering A Game Kit, Please Select The Appropriate Kit For Your Carpet - otherwise, leave blank)

___Floors That Teach        ___Fun & Games        ___Games That Teach        ___Kid's Quest
___Joy Games                  ___Teach-A-Tot            ___Teacher's Pet                ___Teaching Tracks

If Ordering Game Component Kit, Enter 49.00 Here___________
(If You Are NOT ordering A Game Kit - Just Leave Blank)
Add The Amount Of Your Carpet/Flooring Purchase + Amount Of Game Kit (if applicable) To Determine The Total Amount To Be Remitted.
Enter Total Amount You Are Remitting:
Mail this form along with your check or money order to:

Value Carpet
8 Tuscan Drive
Freehold, N.J. 07728

Any Order Paid By Certified Check or Money Order Will Be Expedited And Shipped Within 24 Hours Upon Payment Receipt. If you are paying by (uncertified) Personal Or Business Check, your order will be shipped within 14 business days of payment receipt.