Name *

First Name

Last Name

Phone *

(###)

###

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Select Product *

Aura Gold Wine Glass

Event Date *

MM

DD

YYYY

Event Start Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

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Name *

First Name

Last Name

Phone *

(###)

###

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Select Item *

Aura Blush Wine Glass

Event Date *

MM

DD

YYYY

Event Start Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

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Name *

First Name

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Phone *

(###)

###

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Select Product *

Vintage Colored | Purple Goblets

Event Date *

MM

DD

YYYY

Event Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

(###)

###

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Select Item *

Aura Amethyst Wine Glass

Event Date *

MM

DD

YYYY

Event Start Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

(###)

###

####

Select Item *

Aura Sage Wine Glass

Event Date *

MM

DD

YYYY

Event Start Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

(###)

###

####

Select Product *

Vintage Colored | Pink Goblets

Event Date *

MM

DD

YYYY

Event Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

(###)

###

####

Select Item *

Aura Onyx Wine Glass

Event Date *

MM

DD

YYYY

Event Start Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

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Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

(###)

###

####

Select Item *

Aura Blue Wine Glass

Event Date *

MM

DD

YYYY

Event Start Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Name *

First Name

Last Name

Phone *

(###)

###

####

Select Product *

Vintage Colored | AMBER GOBLETS

Event Date *

MM

DD

YYYY

Event Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Name *

First Name

Last Name

Phone *

(###)

###

####

Select Product *

Vintage Colored | GREEN GOBLETS

Event Date *

MM

DD

YYYY

Event Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Name *

First Name

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Phone *

(###)

###

####

Select Product *

Vintage Colored | DARK BLUE GOBLETS

Event Date *

MM

DD

YYYY

Event Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

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Zip/Postal Code

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Name *

First Name

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Phone *

(###)

###

####

Select Product *

Vintage Colored | WHITE MILK GLASS GOBLETS

Event Date *

MM

DD

YYYY

Event Time *

Hour

Minute

Second

AM PM

Event Address

Address 1

Address 2

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Zip/Postal Code

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Name *

First Name

Last Name

Phone *

(###)

###

####

Select Product *

Vintage Colored | Crystal CHAMPAGNE Coupe

Event Date *

MM

DD

YYYY

Event Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

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Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

(###)

###

####

Select Product *

Tortoise Glass

Event Date *

MM

DD

YYYY

Event Time *

Please specify the start time of the event?

Hour

Minute

Second

AM PM

Venue Address *

Please provide the venue address. This will determine the delivery costs.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

(###)

###

####

Select Product *

Vintage Colored | Crystal GOBLETS

Event Date *

MM

DD

YYYY

Event Time *

Hour

Minute

Second

AM PM

Event Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Phone *

(###)

###

####

Select Item *

Copper Tumbler

Event Date *

MM

DD

YYYY

Event Time *

Hour

Minute

Second

AM PM

Event Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country