THE GLASSVINE
O R D E R   F O R M
  
Please print out this order form. Fill in the following information and send it in with your payment (money order or check ) to:
The Glass Vine
P.O. Box 3521
Springfield, MO 65808-3521

Item Design and/or Words Qty. Price Total Amount
Suncatcher(w/Design)-Oval ___________ ______ $13.00 (s/h $4.50) $____________ 
Suncatcher(w/Design)-Diamond ___________ ______ $13.00 (s/h $4.50) $____________ 
Bevels(w/o lead frame)-Oval ___________ ______ $ 9.50 (s/h $4.50) $____________ 
Diamond Bevels-no lead frame ___________ ______ $ 8.50 (s/h $4.50) $____________ 
Candle Stand w/oval front(design) ___________ ______ $25.00 (s/h $7.00) $____________ 
Flute Champagne-Signature set(2) (w/2names,date) ___________ ______ $22.00 (s/h $5.- set) $____________ 
Flute Champagne-__________set(2) ___________ ______ $_______ $____________ 
Goblet set (4) w/design or initial ___________ ______ $30.00 $____________ 
Goblet set(4) - 2nd set ___________ ______ $24.00 $____________ 
Goblet single w/design or initial ___________ ______ $ 8.00  $____________ 
Benidorm 15oz Cold  MUG(name/design/name+design) ___________ ______ $9/$11/$13-(s/h.$5.-/mug, add $2.50 for each addtn'l) $____________ 
Sport 15oz Cold Mug("/""/""") ___________ ______ $9/$11/$13- $____________ 
Tankard 15oz Cold MUG ___________ ______ $9/$11/$13- $____________ 
Haworth 10oz Hot/Cold Mug ___________ ______ $7/$9/$11 $____________ 
Irish coffee Hot/Cold 10oz MUG ___________ ______ $8/$10/$12.- $____________ 
Nordic 20oz Hot/Cold MUG ___________ ______ $8/$10/$12- $____________ 
Nordic Mini(3.5oz) MUG ___________ ______ $5/$6/$6.50 $____________ 
Wine Glass single (w/design or initial) ___________ ______ $ 8.00 (s/h $6.-) $____________ 
Wine Glass single (w/name & date) ___________ ______ $10.00 (s/h $6.-) $____________
Pitcher(2 words or monogram)+ Tumblers set (insignia) ___________ ______ $29.00, $33.-(7 pc), S-10 $____________ 
Pitcher(Design/monogram) & 4tumblers set ___________ ______ $30.00(no ltr on tumb),$36(1 ltr on tumb) $____________ 
   Additional tumblers ___________ ______ $2.00 $____________ 
Additional Request: _______________________________ $____________ 
Shipping charge if known: $____________ 

Grand Total
$____________

* ($1.00 delivery charge for Springfield, MO.) 
Please contact us for shipping charge (if not indicated) and add to the grand total. 
(We ship UPS or USPS parcel/priority.)
 

Shipping Information


Customer Information:(all fields are required)

First Name: _______________________
Last Name: _______________________
Street Address: _________________________________
Street Address: _________________________________
City:  _______________________
State:  _______________________
Email _______________________    
Zip:  _______________________
Phone:  (____) __________________   <-- required.

SHIP TO (If different from the customer address)

Street Address: ______________________________________
Street Address: ______________________________________
City:  _______________________
State: _______________________
Country:  _______________________
Zip:  _______________________

Print out this order form
Send your payment (check/money order) made out to:

The Glass Vine, PO Box 3521, Springfield, MO 65808
Fax number: (417)890-7804 or 1-720-302-1761

NOTE: Returned checks are subject to a $20.00 service charge.
U.S. Currency Only!    No C.O.D.   Do NOT send CASH!



 
 
 


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