Order Form

  1. Please fill out the form below.
  2. Print it.
  3. Enclose it with your broken frame in a protective packaging and mail it to our address at one of the two locations. Please enclose with your order a check of $40.00 per frame plus $4.50 for shipping and handling. If paying by credit card please fill out the appropriate fields below (credit card number, expiration date, name, etc).

First Name: M.I.: Last Name:

Mailing Address:      
                                   
                    City:        , State: Zip Code:

E-Mail Address: @

Number of Frames:   

Payment Method: Check: Money Order: (check one that applies)

Type in your comments or instructions: 

  

                                                               

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