QUILT ORDER FORM

Kilts Quilts N' Stuff
C/O 213 DeLee Drive
Kingsport TN. 37663

To order by mail, print and fill out order form and send to above address.
Make Money order or cashier's check, to Susan Leenders Ent.

Basic Color Scheme Of Quilt____________________________
(eg: red, green, dark green, pink, etc.)
Designs For 4 Corners
(use number listed under the design on web page)
1.________________ 2._______________
3.________________ 4._______________
Information For Center Piece
Name_______________________________
Date________________________________
Weight______________________________
Length______________________________
If you wish to place a short quotation or poem on the center panel,
please Email it to us before you send in your order, so that we can
let you know if it will fit.

MY ORDER------______Quilt(s)@$49.95 ---------$____.____
                                                            Shipping-------$6.00 ($20 Outside USA)
                                                 8.5% Sales Tax---$____.____(Tennessee Residents Only)
                                                      TOTAL--------$____.____

CREDIT CARD INFORMATION
VISA___MASTER CARD___AMERICAN EXPRESS___DISCOVER___

NUMBER__ __ __ __ | __ __ __ __ | __ __ __ __ | __ __ __ __EXPIRATION DATE_____________
NAME ON CARD________________________SIGNATURE_____________________________

------------------------------------------------------------------------------------------------------------------------------- SHIP TO:
Name:______________________________________
Street_____________________________________
City_______________________________________
Zip/Postal Code__________________
Phone Number(____)_____________