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.

commglass@earthlink.net

Name_________________________________________________

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)

$4.99

$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____________________________________________________