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?

QTY ITEM NAME/DESCRIPTION PRICE TOTALS
    $
    $
    $
    $
    $
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    $
    $
UT Residents Add   6.85% tax -                              
Shipping and Handling : 
Up to $10.00 $6.50
$10.01-$50.00 $8.50
$50.01-$150.00 $10.50
Over $150.00 FREE shipping!

Shipping & Handling  
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:

 

 


quilts, hangers, crafts, crafting books, quilting kits, home decor, luminaries, pillows, americana, country, primitive.

Belinda Pedersen / Owner
1031 N. 500 W.
Orem, UT 84057

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