Patchwork & Paint - Printable Order Form
Print this form for easy mail order. Complete your order,
send
along with your check or money order to:
Patchwork & Paint 1031 N. 500 W.
Orem, UT 84057 |
Questions? |
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ITEM NAME/DESCRIPTION |
PRICE |
TOTALS |
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UT Residents Add 7.25% tax -
|
Shipping
and Handling :
Up to $10.00 |
$6.50 |
$10.01-$50.00 |
$8.50 |
$50.01-$75.00 |
$10.50 |
$75.01-$149.99 |
$12.00 |
Over $150.00 |
FREE shipping! |
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Shipping & Handling |
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TOTAL ORDER |
|
CREDIT CARD INFORMATION |
Name on Card -
|
Card Number -
|
Exp.date Circle
One: VISA M/C American
Express Discover |
CUSTOMER INFORMATION |
Customer Name |
Address |
City State Zip
Code |
Home Phone # Work
Phone # Email
Address
|
GIFT OPTION |
Is this order being sent as a gift? Yes No |
Your Gift Message: |
|
Belinda Pedersen / Owner
1031 N. 500 W.
Orem, UT 84057
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