NAME _____________________________________________ STREET ADDRESS _____________________________________________ CITY _____________________________________________ STATE _________________ POSTCODE__________ COUNTRY __________________________ HOME PHONE _____________________ BUSINESS PHONE _____________________ MOBILE PHONE _____________________
| PRODUCT NUMBER eg #pan001 |
PRODUCT TYPE eg Pansy print |
QUANTITY eg 1 metre |
PRICE eg $14.00 |
| ______________ | __________________________________ | _________ | $___________ |
| ______________ | __________________________________ | _________ | $___________ |
| ______________ | __________________________________ | _________ | $___________ |
| ______________ | __________________________________ | _________ | $___________ |
| ______________ | __________________________________ | _________ | $___________ |
| ______________ | __________________________________ | _________ | $___________ |
| ______________ | __________________________________ | _________ | $___________ |
| SPECIAL ORDERS | PRICE | ||
| __________________________________________________________ | $ ___________ | ||
| __________________________________________________________ | $ ___________ | ||
| FABRIC TOTAL | $ ___________ | ||
| ORDER TOTAL | $___________ | ||
| Postage charges will be added to the cost of your order. See our Orders page for postage charges | |||
| Name on Card | _________________________ |
| Card Number | ______ ______ ______ ______ |
| Expiry Date (MM/YY) | ____/____ |
| Signature | _____________________________ |
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