The KOG Glass Gear Shop Order Page

T-Shirts (Circle Size)
--S--M--L--XL-- _____ (Qty.) @ $12.00 = __________
Keepers Poster _____ (Qty.) @  $8.00 = __________
Rhododendron Poster _____ (Qty.) @  $8.00 = __________
Bricolage Poster _____ (Qty.) @  $8.00 = __________
Autumn Poster _____ (Qty.) @  $8.00 = __________
Sample Boxes _____ (Qty.) @ $65.00 = __________
CD-ROMs _____ (Qty.) @ $6.75 = __________
Subtotal:  $__________
Shipping and Handling
U.S. residents add $5.00
(Add no shipping if you are ordering only a sample box, or CD-ROM
for continental U.S. shipment.) Please allow 2-4 weeks for delivery.
Please inquire via e-mail for International shipping quote. 		S&H:  $__________
Total:  $__________
Payment Method (Select One)
Check_____          Money Order_____          Mastercard_____          Visa_____

Make Check or Money Order payable to:
Kokomo Opalescent Glass Co., Inc.
P.O. Box 2265
Kokomo, IN 46904-2265

Credit Card Number:_______-_______-_______-_______   Exp.___/___

Security code:___-___-___

Ship To:

Name: ________________________________________
Address: ________________________________________
City/State/ZIP: ________________________________________
Phone/e-mail: ________________________________________



Billing address if different than ship to:
Name: ________________________________________
Address: ________________________________________
City/State/ZIP: ________________________________________
Phone/e-mail: ________________________________________

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