Printable Order Form
Mail
Form
To: 		Contois Reynolds Stained Glass Magic Studio
1501 Trace Creek Road, Hamlin, WV  25523
Phone: 304.824.5651
ContemporaryMirrors.com
Name
Address
City
State ZIP
Phone E-mail

Item Name or Number Color Price Each Quantity Total
Add Shipping: Sm Mirrors ~ $20 ; Midsize ~ $25 ; Lg ~ $40 Shipping $
Date of Order: Total Due $

Please make checks or money orders payable to CONTOIS REYNOLDS
Charge cards accepted: Visa, MasterCard, Discover, American Express
Credit Card #
Exp. Date:
Signature CVC Number:
  • We ship nationwide!
    •
  • [  ] Check here if you wish item to be shipped to address other than indicated above  ... please write person's name and their shipping address on back of this form.
    THANK YOU FOR YOUR ORDER!

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