10 S. 059 SCHOGER DR, #40 NAPERVILLE IL 60564
	VOICE: 630-978-9897 FAX: 630-978-9881

1: PRINT THIS FORM FAX ORDER FORM INSTRUCTIONS:   2: FILL IN REQUIRED SECTIONS    3: FAX TO GLASSTEK, INC AT 630-978-9881

CUSTOMER INFORMATION
Name:
Address:
City-State-Zip:
Phone / Special instructions:
Credit Card Number	Card Verification Number *	Visa: _____ MC: _____ Other (Specify)__________	Expiration Date

PART #	YEAR	DESCRIPTION	QTY	UNIT	EXT
Hat		Internet Order - Free Glasstek Embroidered Hat (with purchase)	1

* CARD VERIFICATION NUMBER: THE CARD VERIFICATION NUMBER IS THE 3 DIGIT NUMBER FOUND ON THE BACK OF YOUR CREDIT CARD, TYPICALLY IN THE SIGNATURE AREA.
CANCELLATIONS: ANY ORDERS CANCELLED WILL BE SUBJECT TO A HANDLING CHARGE OF 15%.
SPECIAL ORDERS AND CHARGES: ALL CUSTOM PRODUCTS AND MOLD CHARGES WILL BE PREPAID AND ARE NON-RETURNABLE. ANY PRODUCTS THAT ARE TO BE CUSTOMIZED MUST BE SPECIFIED ON THE ORIGINAL ORDER.
MERCHANDISE RETURNS: NO MERCHANDISE MAY BE RETURNED TO GLASSTEK, INC. FOR ANY REASON WITHOUT WRITTEN AUTHORIZATION FROM GLASSTEK, INC. ALL ORDERS OR MERCHANDISE APPROVED FOR RETURN MUST BE SHIPPED PREPAID AND INSURED, AND MUST BE ACCOMPANIED BY THE ORIGINAL INVOICE OR DATE AND NUMBER OF INVOICE. A SERVICE CHARGE OF 15% WILL BE DEDUCTED ON ALL RETURNED MERCHANDISE EXCEPT IN THE CASE OF FACTORY ERRORS OR DEFECTS. ANY OTHER RETURNED MERCHANDISE MUST BE RETURNED WITHIN 30 DAYS IF A REFUND OR CREDIT IS TO BE RECEIVED.
SHIPPING & PRICING: SHIPPING, CRATING AND BOXING COSTS ARE THE RESPONSIBILITY OF THE CUSTOMER. CALL FOR PRICING.
NOTICE: THERE WILL BE A $20.00 SERVICE CHARGE FOR ANY AND ALL RETURNED CHECKS.