Stellar Glass Order Form
horvath@stellarglass.com       http://www.stellarglass.com            
Print and mail or fax form to:
Stellar Glass, 217 Copper Ridge Trail, Rockvale, TN  37153
p(615) 274-3077, fax(615) 274--6719

Ship To: Bill To:
   
   
   
   
Telephone: Date Ordered:
Email: Date Needed:

Item #		 Quantity Unit Price Description Specify Gold, Frosted, or Clear Detailing Total Due
           
           
           
           
           
           
           
           
           
           
           
           
           
    Sub Total      
    Tax (TN) 9.75%      
    Shipping      
    Total Due      
 

Method of Payment: (Please enclose with order)
Check       Money Order         Visa      MasterCard        Discover
#__________/__________/__________/__________   
Expiration Date:_____________
V-Code (Visa Only) *3 digit # on back by signature line ____________________
Signature of Card Holder: _____________________________________________
Card Holder Name ___________________________________________________
Card Holder Address _________________________________________________
Card Holder Zip Code ________________________________________________