| Name:________________________________________________________________ |
| Mailing Address:______________________________________________________________ |
| City:_______________________________________ State:____________________ Zip:____________________ |
| Daytime Phone:_____________________________ Email:___________________________________ |
| Method of Payment - Check Enclosed (amount)__________________ |
| Credit Card: (Visa, MasterCard) number_______________________________________ |
| Exp date:________________ |
| Signature:______________________________________________________________________ |
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| Quantity: Manufacturer and Item Name: Color(#) Total Price |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| ________ ____________________________________________ ____________ ________ |
| Total for goods ordered: ___________ |
Shipping and handling: For orders up to $5 add $2.00; for orders over
5 to $20 add $5; f
or orders over $20 add $7.50.
Total amount enclosed or billed to credit card:_________________
Send with Credit card (Visa, MasterCard or Discover) info or check or money order (payable to In Stitches) to:
Pam DuBois
In Stiches
2618 Kibby Road
Jackson, Michigan USA 49203
Credit card orders may be phoned in: 517-787-2566