Allegheny Brokerage Company Order Form

132 Howard Street
Pittsburgh, PA 15209
Phone: 800-484-5167
When prompted for a PIN number, enter 1511
Fax: (412) 821-7584
Email:Allegheny Brokerage

Order Form

* Required information to complete this form
Name:	*
Street:	* Apt. #
City:	*
State:	*	Zip:	*
Phone:	*	Fax:
E:Mail:	*
Check the products you wish to order:
Item	Description	Service/6	Service/8
Stemware	3 oz. Port/ Cordial 80024
Stemware	6.5 oz. Wine 80022
Stemware	8.5 oz. Wine 80018
Stemware	11 oz. All- Purpose Wine
Stemware	13 oz. Red Wine 80013
Stemware	11 oz. Goblet 80023
Stemware	5.7 oz. Martini 80020
Stemware	6 oz. Flute 80019
Dinnerware	6¼" Swedish Modern Plate
Dinnerware	8" Swedish Modern Plate
Dinnerware	10" Swedish Modern Plate
Dinnerware	13"Swedish Modern Platte
Preferred delivery method:
UPS Ground UPS Next Day UPS 2nd Day USPS
Comments: Indicate the best time to reach you. Add any additional comments. The best time to contact me is:

Upon completing the following information, please click "Submit Order". An Allegheny Brokerage staff member will contact you to finalize the details of your order, make the necessary payment arrangements, and advise you of stock availability. Please note that for UPS delivery, a street or apt. address is required.