Name:

Designer Glass International
1050 Hook Road
Farmington, NY 14425
Office 585-924-2186
Fax 585-924-7680

Jeff Menhart
National Sales Manager
Cell: 585-208-7900
jmenhart@dgiglass.com

Note: Glass used in the window design can all be the same color, or all different colors. We do not capture this information at this stage.

After this form is processed it will be reviewed by one of our customer service specialists and you will be contacted shortly thereafter. We will assess your needs, provide more product information, or begin the order process based on your needs.

Thank you for choosing Designer Glass International.

Address:

City:

State:

Postal Code:

Country:

Phone:

Fax:

E-mail:

Company:
(if applicable)

Window Pattern(s) of Interest:

Grid Color Desired:

Additional Comments:

Pewter

Brushed Nickel

Light Bronze

Dark Bronze

Antique Brass

Gold