Community Stained Glass Bevel Cluster Order Form

To order, complete and mail to:  Community Stained Glass, 2701 Ripple Ct., White Lake, MI  48383.  Or fax to: (248)684-4151.  Questions or order by phone (248) 684-1153.


Shipping Address________________________________________


Telephone Number (      )   _____ - ________________ ext. ________


Item Number Item Description Quantity Price Per Item Total

Sub Total


Michigan residents add 6% Sales tax


Shipping/Handling (World wide shipping add $9.85 for 1st item $3.00 each additional item)


$1.00 each additional item

Total Amount


*Please make checks or money orders payable to: Community Stained Glass, Inc.

*Please enclose check, money order, or furnish credit card information

Credit Card Payments:

circle one                   

Name as it appears on card:________________________________________

Credit Card No.:_________________________________________________

Expiration Date:_________________ Phone No.:_______________________

Signature X____________________________________________________