Glass Decor and More9312 E US Hwy 40Martinsville, IL 62442 Fax: 888-262-0831 |
Fax/Mail
Order Form
To print this form, simply click on File and then click
Print on your web browser.
We accept Visa, Mastercard, Discover, and American
Express.
| Name: | |
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| Address: | |
| City, State, Zip: | |
| Phone Number: | |
| Email (for order confirm.): | |
| Credit Card Type: | |
| Credit Card #: | |
| Expiration Date: | |
| Name on CC & billing address: (if different than above) |
| Quantity (feet in length) OR Number of Samples |
Description | Price per Foot | Total |
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Shipping Chart
Please email us for Int'l shipping rates. Shipping for samples is free. |
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| Signature: |
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