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 This form will allow you to quickly order , for larger quantity orders please call our Corporate office Custom Glass Etching at 702.586.4330
Packing, handling and shipping charges for UPS Ground delivery to
48 contiguous states only $22.00. Ground delivery usually is 7-10 days
after completion of order. You will have a confirmation of your order within 48 hours after you order, exclude week-ends and Holidays. Expedited shipping, please call 702.586.4330

Billing Information

Promo Code

Contact Name*

Company Name

Address (No PO Box Please)*

City*

State*

Zip*

Phone*

Email*

Payment Method (No Debit Cards Please)*

Name On Credit Card*

Credit Card Number*

Expiration*

CCID#*

As an added security measure, we ask that you enter an extra 3-4 digit number located on the back of your credit card, on or near the signature panel, called the CCID. (American Express customers have a 4 digit CCID located on the front of the card.)

Glass Slipper Size*



Shipping Information


Shipping Address Is Same As Billing Address Yes

**Do Not Fill-Out if Same as Billing Address.**

Contact Name*

Company Name

Shipping Address*

City*

State*

Zip*

Phone*



Glass Slipper Inscription

8" Slipper Inscription

Inscription 30 characters maximum per line (a space is counted as a character)

Line 1 (Free)

Line 2 (Free)

Line 3 for 8" slipper only (Add $15.00 )

Line 4 for 8" slipper only (Add $15.00 )

Gold Filled Inscription? Add $10.00  Yes No

4" Slipper Inscription

Inscription 25 characters maximum per line (a space is counted as a character)

Line 1 (Free)

Line 2 (Free)

Gold Filled Inscription? Add $10.00  Yes No



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