Page Title

Glass Frame Gift
Order Form

Your name:

Your email address:

Your phone number:

Glass Frame number

Choose color of trim on frame.
Most frames come with choice of
either silver or gold unless
specified as only one color
available.

Artwork background

Poem number or first
name for gift

Poem opening or
sentiment (recipient
name or wording)

Poem closing or
sentiment (your name
or wording)

Comments:
Additional information
or names for name gift

Shipping information

Name

Address 1

Address 2

City

State

Zip code

Method of payment

Credit card number

Expiration

CVV code from
back of card (last 3
numbers)

Please provide billing name and address
information if different than shipping information.

Your order total plus taxes and shipping charges will be emailed to
you before your order is processed.
No charges will be applied until your order is shipped.
Payments by check or money order must be received prior to your
order being shipped.
Please allow up to 2 - 3 weeks to receive your order.
In most cases your order will be shipped within 2-3 days.

Thank you for your order.
Your order has been submitted.
You will receive a confirmation email with
the total charges and expected shipping date within 2 days.
If you are paying with check or money order you will receive the address to
send your payment to.
Thank you