To place an order print out this form fill it out email it.....Thank you.

[   ] Previous Customer  [   ] New Customer   (Please check the appropriate box)

Name: ________________________________ Phone: __________________
Address: _______________________________________________________
City: _____________________ State: ___________ Zip code: ____________
Country: _________________________ Email: ________________________
Visa/MC #: _____________________________________ Exp Date: _______
Signature: _________________________________________________
Billing Address if different from ship to: Name_______________________
Address: _______________________________________________________
City: _____________________ State: ___________ Zip code: ____________

Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________
Id#_________Qty_______Description___________________________Price_________Sub-Total_____________

Total: _________________ 

Thank-you for your order.

[Home][Craft Shells][Craft Ideas][Wholesale Mirrors] [Order Form] [Storage Needs] [Email]