Lampwork Bead Order Form
	Name Address City State Zip Code Phone [Format xxx-xxx-xxxx] Fax [Format xxx-xxx-xxxx] Email Ripple 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 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.