ORDER FORM
YOUR INFORMATION
ANCHOR BATH CHAIR
ANCHOR BATH CHAIR ACCESSORIES
AN1400 Anchor Bath Chair, Sm
AN1600 Anchor Bath Chair, Lg
BATHCHAIR
Fax to 718.878.2283 • Email to [email protected]
68 35th Street, Brooklyn, NY 11232 T: 718.943.6452 F: 718.878.2283 www.circlespecialty.com [email protected]
ITEM # QTY DESCRIPTION MSRP
ITEM # QTY DESCRIPTION MSRP
Company: Ship To:
Account Number: Date: Address:
Quote PO Number: City: State:
Contact: Zip: Phone:
Email: Marked For:
AN2100 Anchor Rolling Shower Base
AN2110 Lateral Support
AN2111 Positioning Straps, XL, Pair
$645.00
$65.00
$38.00
$640.00
$660.00
