Lampwork Bead Order Form

Name Address City State Zip Code Phone [Format xxx-xxx-xxxx] Fax [Format xxx-xxx-xxxx] Email Disc Beads   Color Quantity Price A1 Gold   $2.40 A2 Silver   $2.40 A3 Pink   $2.40 A4 Blue   $2.40 A5 Copper   $2.40 A6 Seafoam   $2.40 B1 Turquoise/Gold   $2.40 B2 Grape   $2.40 B3 Blue/Copper   $2.40 B4 Blue/Gold   $2.40 B5 Emerald/Blue   $2.40 B6 Blue/Blue   $2.40 B7 Lilac/Blue   $2.40 B8 Lilac/Gold   $2.40 B9 Lilac/Pink   $2.40 B10 Spring   $2.40 C1 Gold   $2.40 C2 Pink   $2.40 C3 Blue   $2.40 C4 Seafoam   $2.40 C5 Copper   $2.40   Payment can be made by Paypal, details will be provided at the time of order.