The
 BOLSTA ®
Support Cushion

Ordering/Pricing-printout form
Fill out the following in block capitals and Fax or Mail making payment to :

Fax: +41 21 964 71 41
Arabesque Commercial SA
Case  Postale 9
CH-1815  Clarens-Montreux
Switzerland

My address:

Family name:          ___________________________    Mr   ____   Mrs   ____   Ms.   ____   

First names:            ___________________________     

Street & Number:   ___________________________
Place & Postcode: ___________________________
Tel:                          ___________________________
Fax:                         ___________________________
Email:                     ___________________________

For myself:  ___    For a gift:  ___

Address of recipient:

Family name:          ___________________________   Mr   ____   Mrs   ____   Ms.   ____   

First names:            ___________________________      

Street & Number:   ___________________________
Place & Postcode: ___________________________
Tel:                          ___________________________
Fax:                         ___________________________
Email:                     ___________________________

Delivery:      Switzerland               Europe               Elsewhere
                      Allow 7 days      Allow 14 days    Allow 28 days

Method of payment:

Please debit my credit card:
Eurocard/Mastercard    ____    Visa    ____    Amex     ____    
or On invoice by bulletin de  versement 15 days net     ____    
Card No.                      __  __  __  __  .  __  __  __  __  .  __  __  __  __  .  __  __  __  __
Expiry Date:                  ___________________________

Signature:                      ___________________________    Date:  ____________________

Product List:

CUSHIONS:   
(Supplied with one zipper-closure  white cover 100% cotton.)

Description:                       Weight:                         Price:              Qty:             Total:
                                                                                CHF    EUR                           CHF   EUR

Bolsta  No.1:                          1,7 kg                     179.-     120.-           __               ____

Bolsta  No.2:                          1,9 kg                     195.-     130.-           __               ____
+ PU "skin"
water-resistant

Bolsta  No.3:                         2,1 kg                      199.-      132.-          __               ____
+ PU "skin" & 
 fire-retardant

COVERS:     (Indicate number of additional covers required.)
                   Note: For hygenic reasons, returned cushions and covers  cannot be accepted
                   unless returned within 7 days in perfect condition in the original packaging.

Description:                                                                Price:              Qty:             Total:
                                                                                   CHF    EUR                           CHF   EUR

    "Boudoir"    100% Cotton
A:  White   Plain Satin                                            55.-      37.-          __             _______
B:   White    Diagonal stripe Damasc                    65. -     43.-          __             _______

    "Maternity" 100%  Cretonne cotton  
C:  Peach/animal design                                         59.-       39.-          __             _______

    "Picnic"       82% Polyester/18% Cotton 
D:  Multicolor                                                          59.-       39.-          __              _______

    "Boudoir"   100% Cotton 
      Diagonal stripe Damasc 
E:  Rose                                                                    69.-      46.-           __               _______
F:  Vanilla                                                                 69.-      46.-           __               _______
G:  Lavande                                                              69.-      46.-           __               _______

    "Salon"        50% Polyester/50% cotton
      Diamond / Dot design
H:  Ecru                                                                     79.-      52.-            __                _______
I:   Saumon                                                                79.-      52.-            __                _______
J:   Blue                                                                      79.-      52.-            __                _______
K:  Pistache                                                               79.-      52.-            __                _______

                                                                                                      Sub Total CHF / EUR: ____

Shipping: Postage, packaging & insurance charges:
                      Switzerland           Europe              Elsewhere
                      included              CHF 35.-               CHF 60.-                                                        Add: _____
                                                EUR 24.-               EUR 40.-

                                                                                                               Grand Total CHF / EUR: ____