Easy Order Form
Order Online at www.e-e-stainedglass.com

E&E Stained Glass Studio
4066 Jefferson
P.O. Box 50
Clarklake, MI 49234
1-800-579-4074

www.e-e-stainedglass.com

Please print carefully and accurately and enter all information to ensure prompt and correct delivery. Use the “Style, Size or Color space if a choice is offered. DOUBLE-CHECK YOUR ORDER BEFORE SENDING.

ORDERED BY:

NAME:____________________________
ADDRESS:_________________________
CITY, ST, ZIP_______________________
PHONE:___________________________
E-MAIL____________________________

SHIP TO:

NAME:___________________________
ADDRESS:________________________
CITY, ST, ZIP______________________


METHOD OF PAYMENT:
_____ Check
_____ Money Order
_____ Certified Check
_____ Credit Card


Credit Card Information:
____ VISA   ____ MasterCard   ____ Discover   ____ AMEX
Card #:________________________________________
Expiration Date:_________________________________
Verification # (last 3 digits on back of card)_______

Signature:______________________________________

QTY

ITEM NUMBER

ITEM DESCRIPTION

STYLE, SIZE OR COLOR (if choice is offered)

PRICE EACH

EXTENDED TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Merchandise Total

 

Sales Tax (MI residents add 6%)

 

Shipping and Handling (chart at left)

 

GRAND TOTAL OF ORDER

 

    Shipping Rates
(all Currency in US Dollars)

    $ 0.01 - 24.99  $ 6.00
    $25.00 - $49.99  $ 8.95
    $50.00 - $99.99  $14.50
    $100.00 - $199.99  $20.00
    $200.00 and up  $30.00