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Order Form |
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Note: All of our work is professionally created, one at a time - no 'factory output'. Please be patient. If you provide your email address as requested, we will keep you up to date & let you know when your order has been shipped. (Select "Print" in your browser to print this form.)
1. Your Name: ________________________
Street/shipping address:_______________________
City: _________________ State: _________ Zip: _______
Email address:_______________ [So we can let you know when your
glass is ready for pickup (Albuq.) or when it has been shipped.]
Phone number (Albuq. only, to call for pickup) _________
2. "Flowers in Glass" (if several are ordered, put the number desired by each color)
Choose Stained glass edge color – flowers will be chosen to match:
| __Artist's choice | __Aqua | __Pink | __Purple |
| __Blue | __Orange | __Red | __Yellow |
| __Clear with snowflake pattern | __White | __Lavender | Other color: We'll match it if we can! _________ |
3. Etched Bevels (clear glass, beveled edge, etched with design chosen)
(if several are ordered, put the number desired by each design name & indicate desired
stained glass edge color by each- choose color from list in 2. above)
| Etching: | __Mountain scene | Stained glass edge color __________ |
| __Cardinal | Stained glass edge color __________ | |
| __ Humming bird/flower | Stained glass edge color __________ | |
| __ Rose | Stained glass edge color __________ |
4. Write check for payment
| (Payable to Gary Shepherd) | number | cost ea | amount enclosed |
| Flowers in Glass | _____ | $32.00 | $ _____ |
| Etched Bevels | _____ | $30.00 | $ _____ |
| TAX (NM only, $1.80 per piece ordered): | $ _____ | ||
| Shipping (if used): | |||
| (1 glass- $8.00, add $3 for each additional glass ordered) | $ _____ | ||
| TOTAL ENCLOSED: | $ _____ |
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5. Mail this form, and your check to: |
Our Email and phone: |
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We appreciate the opportunity to bring |
