Print & mail this form or call 866-733-8542 to place your order

Purchase Order Form

     Hand Blown Glass Co
601 E Lake Ave. Wisconsin Dells, WI 53965    phone (608)254-7054    Email    info@handblownglass-gifts.com
mail order form to above address or phone in for faster service (please have all info ready when you call)

SHIP TO: BILL TO: (leave blank if billing and shipping are the same)

Payment Method

money order	Amount enclosed	Order #
Credit Card Type	Card #	Expiration date
3 digit security code		Phone #
Name on card	Date needed	Order Date
email address (for order confirmation)

Please supply the following items

ITEM NO. DESCRIPTION QTY COST EACH TOTAL AMOUNT

Ordered by Subtotal

Shipping charges (from chart)

Special Handling charges

Sub Total

WI sales tax 6%

Total Due

Thank You For Your Order!!!

A confirmation will be sent to your email address after shipment of product(s)

Special Instructions