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 |
|
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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)
