10% OFF ALL MIRRORS from Sale Price thru 9/30/05

Quality Mirrors

Fax Order Form

Fill out and Fax to: 800-734-0285

Name:_______________________________________

Address:___________________________________________________________

City:_______________________

Phone:______________________

State:________

Zip:_________________

Fax:________________________

Email:_________________________________________

Item #:________________

Item #:________________

Item #:________________

Size:________________

Size:________________

Size:________________

Frame #:______________

Frame #:______________

Frame #:______________

Payment Method:

Check  or   Credit Card #____________________________ Exp. Date:___________

Comments:_________________________________________________________ _________________________________________________________________ _________________________________________________________________  _________________________________________________________________

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