Please provide the following BILLING information:

Bill To:
Buyer's Name
Company Name
BILL To Address	Address 1   Address 2
City
State	AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Zip+4 / Postal Code	-
Phone
FAX
E-mail Address

Please provide the following PRICING & PAYMENT information:

Active Wholesale Account?	Yes     No     If YES: Please Select Price Level Bronze Silver Gold (Do Not Know)
Method of Payment:
Bank Card (on file)* . . .	Last Four Digits:      Expires: 01 02 03 04 05 06 07 08 09 10 11 12 (month)    2008 2009 2010 2011 2012 2013 2014 2015 (year)
*If this is your first time ordering from Franklin Art Glass please call us at 1.800.848.7683 with your bank card information, 8 am til 4:30 pm Eastern Standard Time. We accept American Express, MasterCard, or Visa.
C.O.D.	Prepay (order will be held until payment is received).
Pre-Authorized Net 30 Days	Due On Receipt of Order (orders for pickup only)

Please provide the following SHIPPING information:

This order is for PICKUP
Pickup Date & Time:	(mm/dd/year)              (approximate time)
SHIP TO:	Ship to address is same as Bill To Address
Company Name
Attention To
SHIP to Address:	Address 1   Address 2
City
State	AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Zip+4 / Postal Code	-
Phone

Please provide the following SHIPPING INSTRUCTIONS:

SHIP BY:
UPS Ground Service	Truck:    Carrier: Choose One of the Following... ABF UPS Freight Yellow OTHER***
UPS Next Day Air	***If "OTHER" please offer your PREFERENCE:
UPS Second Day Air	Liftgate Service Required.
UPS 3-Day Select
UPS Shipping Charges: Prepay & Add to Invoice Collect*/UPS Acct No.	Freight Charges*: Prepay & Add to Invoice Freight Charges Collect
*Any discount you have negotiated with the Freight company will supersede any discount rates negotiated by Franklin Art Glass when shipping "Freight Charges Collect"
ADDITIONAL ORDER & SHIPPING INSTRUCTIONS:

ITEMS  TO ORDER :

Catalog Number	Quantity / Units	Description
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT

 

Catalog Number	Quantity / Units	Description
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT
-	Unit: Please Select Unit Each Pieces Box(s) Case(s) Roll(s) Small UPS Glass Large UPS Glass Full Sheets Cut for UPS Full Sheets UNCUT