Fiberglassscreens - Mail Order Form

Fiberglass Mail Order Form
Please print and then fill in information and send to address below.

E-Mail				SHIP TO (IF DIFFERENT)
Name				Name
Address				Address
City/St/Zip				City/St/Zip
Daytime Ph #				Daytime Ph #

Screen Size	Qty		Description		Unit Cost	Total
84 inch width screen		Screen
96 inch width screen		Screen
		Screen
		Screen
Screen roll size	# rolls	Description
84 inch X 100 feet		A roll of screen material			$ 183.95
96 inch X 100 feet		A roll of screen material			$ 203.00
		Screen Attachment devices
&

	.
					Subtotal:
Shipping is $12.50 per order of cut screen or Screen attachment devices					Shipping:
Shipping is $ 35.00 per roll of screen					Total:

Please make check payable to Porch Screens

Fiberglass Screens
55648 Silver Creek Lane
Macomb Twp, Mi 48042
FORM 103 rev Dec 03