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600 N. Cleveland Avenue | Suite 210 | Westerville, Ohio 43082 +1-614-523-3033 Office +1-614-818-9485 Fax www.gmic.org Glass Manufacturing Industry Report Order Form To purchase the GMIC Glass Manufacturing Industry Report, complete this form and send it along with payment information to Donna Banks by fax (+1-614-818-9485) or email ([email protected]) or by mail to the GMIC address as listed above. Upon receipt of payment, the report will be emailed to the indicated contact as an attachment files in Adobe PDF and MS-Excel formats. If payment is made by check, payment must clear bank processing before the report is mailed. CUSTOMER INFORMATION Contact Name Company Name Street Address City | Providence State | Zip Country Phone Number Email Address NOTE: The above email address is where the report will be sent

Glass Manufacturing Industry Report Order Formgmic.org/wp-content/uploads/2018/01/GMIR-Order-Form-18.pdf · Glass Manufacturing Industry Report Order Form. To purchase the GMIC Glass

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Page 1: Glass Manufacturing Industry Report Order Formgmic.org/wp-content/uploads/2018/01/GMIR-Order-Form-18.pdf · Glass Manufacturing Industry Report Order Form. To purchase the GMIC Glass

600 N. Cleveland Avenue | Suite 210 | Westerville, Ohio 43082 +1-614-523-3033 Office +1-614-818-9485 Fax

www.gmic.org

Glass Manufacturing Industry Report Order Form

To purchase the GMIC Glass Manufacturing Industry Report, complete this form and send it along with payment information to Donna Banks by fax (+1-614-818-9485) or email ([email protected]) or by mail to the GMIC address as listed above. Upon receipt of payment, the report will be emailed to the indicated contact as an attachment files in Adobe PDF and MS-Excel formats. If payment is made by check, payment must clear bank processing before the report is mailed.

CUSTOMER INFORMATION

Contact Name

Company Name

Street Address

City | Providence

State | Zip

Country

Phone Number

Email Address

NOTE: The above email address is where the report will be sent

Page 2: Glass Manufacturing Industry Report Order Formgmic.org/wp-content/uploads/2018/01/GMIR-Order-Form-18.pdf · Glass Manufacturing Industry Report Order Form. To purchase the GMIC Glass

BILLING INFORMATION (if different from customer information)

Billing Name

Company Name

Billing Address

City | Providence

State | Zip

Country

Phone Number

ORDER INFORMATION - payment must accompany order

Pricing

GMIC Member $1,375.00

Non- Member $2,295.00

PAYMENT INFORMATIONI

Payment Type Credit CardCheckPhone

Card Type

Name on Credit Card

Card Number

Expiration Date

CVV

Authorized Electronic Signature

If making payment by phone please complete this form and return it by email to Donna Banks. Email: [email protected]

Copyright 2018 Glass Manufacturing Industry Council

"All rights reserved. No part of the GMIC Glass Manufacturing Industry Report may be reproduced for outside distribution or transmitted in any form or by any means without written permission."