| Name, Shipping Address, Phone Number: |
|---|
| Quantity | Item | Glaze Color | Price Each | Total |
|---|---|---|---|---|
| Method of Payment |
|---|
| Payment by check or VISA, MC, AMEX or phone your order |
| Card Number: |
| Expiration Date: |
| Signature: |
| Subtotal: | |
| IL Res. Add 6.25% Tax: | |
| Shipping 10% of Total ($5 min.): | |
| Total: |