PRO-MAT Dristribtion Company

GLASS VESSEL STAND ORDER FORM

The Glass Art Vessel stand includes a fully assembled stand, and (7) vessel bowls of your choice.
In order to properly order your stand, we ask for the following information.

Company Name:

BILLING ADDRESS:

Name:
Address:
City/State/Zip:

SHIPPING ADDRESS:

Name:
Address:
City/State/Zip:

Telephone:
Fax:

ORDER INFORMATION

Purchase Order Number:

The Glass Art Vessel stand is available at the promotional price of $850.00. Order will not be processed until complete payment information is received and processed. Expect at least 4 days for delivery. You will be notified within several hours to get the your payment information.

(1) MODEL#:
(2) MODEL#:
(3) MODEL#:
(4) MODEL#:
(5) MODEL#:
(6) MODEL#:
(7) MODEL#:

ALL ORDERS WILL BE CONFIRMED VIA FAX.
PLEASE CALL IF YOU DO NOT RECEIVE CONFIRMATION WITHIN SEVERAL HOURS.