Customer Name:________________________________________________________
 
Address:_______________________________________________________________
 
City-State-Zip:__________________________________________________________
 
Phone: (________)____________________ e-mail:_____________________________
 

Quantity	Item Number	Item Description or optional information	Price Each	Total Price
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
-	-	-	$	$
SUB TOTAL				$
(See order page for amount) SHIPPING				$
TOTAL AMOUNT				$

 
Method of payment:
 
_____ Personal Check, Money Order or Bank Draft - Payable to Ceramics Plus (US funds only)

__________ Check Number __________ Amount