TM WOOD PRODUCTS MANUFACTURING, INC.

MANTEL KNOCK DOWN SURROUND ORDER FORM

Effective date August 2002 through July 2003

Select a Model____________

Desired Opening Size: A(Opening Width)=____ B(Opening Height)=____ C(Offset for Facing)=____

If this is a custom kd surround, please provide necessary information below for quote.

Select a Wood:

Red Oak

Clear Pine

Maple

Paint Grade

Knotty Pine

Cherry

Other__________

Select a Finish:

Stn. Medium

Stn. Light

Stn. Dark

Stn. Red Mahogany

Unfinished

Stn. Pickling

Pnt. Primer

Pnt. White

Pnt. Black

Fill in all dimensions that apply below, some may not apply.

Additional Notes:__________________________________________________________________

_______________________________________________________________________________

Fill in all dimensions for fireplace application that apply to this order. Some dimensions may not be

needed or may not apply, such as the absence of a window or wall return. However, be sure to

check for wall switches, electrical outlets or fireplace keys. Consider all obstructions and be as

detailed as possible to any maximum tops, existing shelves or ledges as the diagram indicates.

Note: Ref. Technical Guide in the back of this binder for additional info.

Store Name_______________________ Contact Person_________________________

Phone___________________________ Fax__________________________________

PO#________________________________ Tag Name_________________________________

22900 HOOVER ROAD WARREN, MI 48089

PH. 586 427 2364 FX. 586 427 5617