JOPPA GLASSWORKS, INC.
P. O. BOX 202
WARNER, NEW HAMPSHIRE 03278
(603) 456-3569

ORDER FORM

The best way to order from me these days is to e-mail your shipping and billing address information to me at joppaglass@conknet.com. Then call me with your card number. Or you can do it all on the phone:

603-456-3569.

Please do not e-mail the card information as I don't have a secure server.... it is a Google maintained server and who knows what is being read. If I mention to my daughters that I have a toothache I get pain medication ads poping up. This is rude.

In some form or another I will need the following information to complete your order:

YOUR NAME

YOUR BUSINESS NAME

MAILING ADDRESS (FOR US MAIL)

YOUR STREET ADDRESS (FOR UPS)

CITY, STATE, ZIP

PHONE (BUSINESS & HOME)

YOUR e-mail ADDRESS

MASTER CARD or VISA ACCOUNT NUMBER

_ _ _ _ / _ _ _ _ /_ _ _ _ / _ _ _ _ / (EXP. DATE) _ _ / _ _

(3 number sec. code)_ _ _

YOUR SIGNATURE (If you are mailing this to me.)

X_________________________________

Items you want to order:

_____________________________(ITEM) $_______.____
_____________________________(ITEM) $_______.____
_____________________________(ITEM) $_______.____
_____________________________(ITEM) $_______.____
_____________________________TOTAL $_______.____

If you have any questions please call Dudley Giberson at Joppa Glassworks, Inc. (603-456-3569).

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