Strawberry Wine Order Form
Please print out this form,  or  email  me to place your order.
Send to: GLASS TATTOO
P.O.Box 909
29 Palms, Calif. 92277-0909

  Wine Glasses
Links Page  Main Page
One name per glass.

|Italics/Am.Std | Design #      | First Name                  | First Name                                        |  Price / Set  $10.00 |
|Example |  Italics  |Strawberry  |  Julie                             |  Chris                                                  |          $10.00           |
|                            |                        |                                       |                                                             |                                 |
                                                                                                                                             Pre - Total |                            |
                                                                                                                            Add Ship/Handling |        $10.50          |
                                                                                                                                            Insurance  |       _  $1.85        |                                                                                                                                     Total Enclosed |                            |

Please print and fill out one order form for each set of glasses you wish to order.

Ship to:                                                                        Please be SURE that the information
Name__________________________________         you have provided is ACCURATE!!
Mailing Address_________________________       This is a sandblast process through a
City_________________State______________       handcut stencil.  Once the design and
Zip+4_______________                                              names are on the glass, they can not
E-mail address__________________________        be removed!
Phone Number_________________________

Method of payment (check one)  [ ] Visa  [ ] M/C  [ ] Discover   [ ] Money Order

Name on card_______________________
Card Number_______________________
Expiration Date_____________________
Signature________________________

Allow 4-6 weeks for delivery
Received_____________   Shipped______________
updated 10/02/08