Quilt Closet Mail Order Form

TO ORDER:
Please fill out the following form, print and mail to us with your check, money order, or credit card information to:
Penny Durnin
1793 Ruie Road
North Tonawanda, NY 14120
Phone ((716) 694-6019 
This form can be filled out on-line and printed or printed first and filled out by hand. Make Checks and Money Orders payable to: Penny Durnin.


BILL TO ADDRESS: Areas with red text are required fields.

Type of payment
Visa
Master Card
Check
Money Order

Credit card Expiration Date
mm/yy
Cardholder Name

Card Number
Phone Number
E-mail Address

SHIP TO ADDRESS: If different than billing address

Name
Street address
City
State / Zip
Qty
Description
Item No.
Color
Price Each
Total

S/H (N/A in U.S.)
Shipping method used will be the one most appropriate for your order

Shipping is included in prices shown.
No other shipping charges will be applied for orders in the continental U.S.

New York State residents must include the sales tax for their county.
TOTAL ORDER