Please allow approx. 6 - 8 weeks from receipt
of your order
for completion and shipment.
______________________________________________________________________________
Order Form:
Shipping Address if different from order address:
Name:__________________________________
Name:___________________________________
Address:________________________________
Address:_________________________________
City:____________________________________
City:_____________________________________
State:___________________________________
State:___________________________________
Zip Code:________________
Zip Code:________________
Phone:__________________________________
E Mail Address:_________________________
How did you find out about Patches in Glass? _______________________________
Send the following:
1. Completed Order Form (Please
print off Web site)
2. The patch that you want used for
the Patch in Glass or Ornament
3. A check or money order for the total amount of your order
NEW PATCHES MAKE A BETTER FINISHED PRODUCT
Please Circle which item you are
ordering ( Prices are current for 2012)
1. Patch in Glass - $100 plus S & H
of $20.00 ( $120.00)
2. Ornament - $25.00
plus S & H of $7.50 ($32.50)
3. Ornament with stand - $30.00 plus S & H
of $8.00 ($38.00)
Please make checks or money orders payable to Patches in Glass