Chairs for Charity Order Form

Date:
Phone #:
Fax #:
Email:
Company Name:
Contact Name:
Street:
City:
State
ZIP:
	Delivery Address, If Different:
Delivery Street:
Delivery City:
Delivery State
Delivery ZIP:

PAYMENT INFO

	Please provide me with a Purchase Order:
	Please charge my account - COS account number:
	Credit Card Purchase in lieu of this is a purchase request
	A COS Representative will contact you regarding your credit card information.

CHAIRS

It’s simple... Just purchase any “Chairs for Charity” product and COS will make a donation in your name to YOUR favorite United Way partner agency.

	ME8ERGLO Ergohuman Executive Task Chair Mesh Seat and Back, Mid-Height. Designed and made with total comfort in mind. This series utilizes a synchro tilt mechanism with infinite lock, sliding seat, pneumatic height adjustment and headrest option all in one chair. Sell price: $619.00 Donation: $50 Finish: Black Mesh Quantity:
	MM9500 Apollo Task/Conference Chair High, Mesh Back/Fabric Seat. Seating with a mission. Breathable mesh synchro-tilt backrest and a molded foam waterfall seat are combined with adjustability for out-of-this-world comfort and state-of-the-art control. Sell price: $259.00 Donation: $25 Finish: Black Mesh Back & Fabric Seat Quantity:
	49802A 4x4 Series High Performance Task Chair. A seat to sink into. Standard upholstery options are combined with: a 4-paddle multifunction mechanism; height and width adjustable arms; and back angle, back height, seat angle and tilt-tension adjustments. All these make for superior seating comfort. Sell price: $264.00 Donation: $25 Quantity: Fabrics: Select Black (AT33) Charcoal (H5511) Navy (AT30) Taupe (H5711) Burgundy (AT31)
	FT4547 Racer ST Task Chair Full Function - High Performance Arms. Always ahead of the competition, the Racer accomodates those with intense workloads. So comfortable and responsive, you can’t wait to get started. Sell price: $189.00 Donation: $15 Quantity: Fabrics: Select Black (AT33) Charcoal (H5511) Navy (AT30) Taupe (H5711) Burgundy (AT31)

CHARITY

I want my Chairs for Charity donation to be made to:

 AIM Center, Inc.
 Alexian Brothers Senior Neighbors
 American Heart Assoc.
 American Red Cross, Greater Chattanooga Area
 Big Brothers/Big Sisters of Greater Chattanooga
 Walter Boehm Birth Defects Center
 Boy Scouts of America, Cherokee Area Council
 Boys & Girls Clubs of Chattanooga
 Catholic Charities of Chattanooga
 Chattanooga Goodwill Industries
 Chattanooga Room in the Inn
 Chattanooga’s Kids on the Block
 Children’s Academy for Education & Learning
 Children’s Home/Chambliss Center
 Communities in Schools of Catoosa County
 Council for Alcohol and Drug Abuse (CADAS)
 Epilepsy Foundation of Southeast Tennessee
 Family Crisis Center of Walker, Dade, Catoosa & Chattooga Counties
 Fortwood Center
 Four Points
 Gifts In Kind
 Girl Scouts of Moccasin Bend Council
 Girls Incorporated of Chattanooga
 Hospice of Chattanooga
 Jewish Community Federation of Greater Chattanooga
 LaFayette Area Empty Stocking Fund
 Little Miss Mag Day Care Center
 Maurice Kirby Child Care Center
 Northside Neighborhood House
 Ochs Center for Metropolitan Studies
 Orange Grove Center, Inc.
 Partnership for Families, Children and Adults
 Pro Re Bona Day Nurseries
 Primary Health Care Center of Dade County
 RE:START - The Center for Adult Education
 The Salvation Army
 Signal Centers
 Special Transit Services
 Speech & Hearing Center
 The Team Centers
 Tri-State Food Pantry
 United Way of Greater Chattanooga
 United Way’s Project Ready for School
 United Way’s 211 Information & Referral Service
 United Way’s Volunteer Center
 United Way’s Building Stable Lives
 Urban League of Greater Chattanooga
 Volunteer Community School, Inc.
 Walker County 4-H
 YMCA

 

Contact Us
COS Business Products & Interiors
Corporate Headquarters & Showroom
1548 Riverside Drive, Chattanooga, TN
Phone 423-624-0011
Fax 423-629-9971

Toll Free 800-882-3375 | Fax 877-708-2428
www.cosonline.com