Products by Glas-Col

 

  Ordering Form

This form was generated to help visitors to our web send an  order to us and begin the processing. Complete the required   information fields. A Purchase order number or credit card number is not required to  begin the processing. A representative from the Order  Department will call to confirm the order and a PO or credit card number  can be given at that time along with delivery and shipping charges.
 

This form can only be used for domestic orders only. For international orders please contact us by fax, phone or E-Mail or follow the link below.
 International Sales.


* Required Fields
Use only Alphanumeric characters to fill in the form fields.
Do not include credit card numbers or expiration dates with this form.

Your First Name*:

Your Last Name*:
Your Telephone Number*:
Fax Number*:
A valid E-Mail address is required to process the order.
E-Mail Address*:

Fill in your order details here:

(Example: 
Item ID/QTY2 or Sample, Qty #)

 
Ship to address
Company Name*:
Attention:
Street Address 1*:
Street Address 2:
Mail Code:
City*:
State*:
Zip Code*:
Bill to address
Street Address 1*:
Street Address 2:
Mail Code:
City*:
State*:
Zip Code*:
Purchase Order Number:

Shipping Method

 

 

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   Last Modified 03/29/06

  Copyright 2000-2006 Glas-Col, LLC.