Lampwork Bead Order Form

Name Address City State Zip Code Phone [Format xxx-xxx-xxxx] Fax [Format xxx-xxx-xxxx] Email Collage Beads   Color Quantity Price Gold barrel w/ teal & seafoam swirl. $4.00 Blue barrel w/ pink & silver swirl $4.00 Copper barrel w/ gold & teal swir $4.00 Gold w/ pink & blue swirl $4.00 Seafoam barrel w/ blue & gold swirl $4.00 Pink barrel w/ gold & violet swirls $3.50 Teal barrel w/ copper & seafoam swirl $3.50 Blue barrel w/ copper & gold swirl $3.50 Violet barrel w/ teal & blue swirl $3.50 Blue barrel w/ spring green & copper swirl $3.50   Payment can be made by Paypal, details will be provided at the time of order.