Derby Glass Order Form

The Derby Glass Page Order Form

Thank you for your order.
To place your order complete the form below and click on "Send It Now" at the bottom. If you do not choose to use the PayPal online payment option you may call us at (502) 363-1973 with your Credit Card number.

If you prefer a printable form that you can mail or fax, click here. Or, you may wish to E-Mail your order to to joe@derbyglass.com.

If you prefer to order by phone please call Joe Boone at 502-363-1973.

Pay Securely Through PayPal !
We're VERIFIED so Buyer Protection is guaranteed.
Please Note that if you have PopUp Blocker activated, you may have to hold down the Control Key for the Paypal link to work properly.

Name and address of person placing order:

 First Name   Last Name

 Address Line 1 (No PO Boxes Please)

 Address Line 2

 City   State     Zip Code

 Phone Number

 E-Mail Address (Required)

NOTE: Unless otherwise specified in the "Comments" block below,
your order will be shipped to the above address:

Please enter the Item Numbers of selections:

Item Qty.Description $ Price

Item Qty.Description $ Price

Item Qty.Description $ Price

Item Qty.Description $ Price

Item Qty.Description $ Price

Item Qty.Description $ Price

Shipping/Handling Costs

       $  Kentucky Residents 6% Sales Tax

       $  Order Total

NOTE: The delivery charges are based on shipping within the 48 states. All orders are shipped via US Post Office or UPS ground unless otherwise requested in the "Comments" block below. Please make checks or Money Orders payable to "Triple Crown Collectibles and mail to this Address

Payment Options:

Please Select One.

Note: If you are sending a check or money order please make checks payable to "Triple Crown Collectibles" and Click here for the Address.

If you wish to use a Visa or Master Card, please call us at 502-363-1973.

After submitting your order below you may return here and use PayPal by clicking your "Back" button. A click on the logo below will allow you to pay Securely Through PayPal !
We're VERIFIED so Buyer Protection is guaranteed.

If you have any questions, COMMENTS or special instructions please enter them here.

If you are finished, please push the appropriate button. Thanks, and we look forward to serving you.

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Mailing Address:
     Triple Crown Collectibles
     PO Box 14293
     315 W. Woodlawn Ave.
     Louisville, KY  40214

This is NOT a secure site.

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