Please allow 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 the Ornament
3. A check for the total amount of your order
Please Note: NEW PATCHES MAKE A BETTER FINISHED PRODUCT
Please Circle which item(s) you
are ordering ( Prices are current for 2008)
3. Patch in Glass - $100
plus S & H of $14.00
4. Ornament - $28.00
plus S & H of $4.00
5. Ornament with stand - $32.00 plus S & H of $4.50
To: Patches in Glass
P.O. Box 9094
Tucson, AZ
85738
Please make checks payable to Patches in Glass
Pay by using Paypal ( Please note that I would prefer a check due to paypal costs, any questions please email me)