Order Form

Quilt Closet Mail Order Form

TO ORDER:
Please print the following form, fill out and mail with your check, money order, or credit card information payable to:
Penny Durnin
1793 Ruie Road
North Tonawanda, NY 14120
Phone ((716) 694-6019

BILLING ADDRESS:	SHIPPING ADDRESS:
Name:	Name:
Address:	Address:
City	City
State / Zip:	State / Zip:
Telephone #:	Telephone #:
Email

Item #	Description	Qty.	Price	Total

All orders shipped via USPS	Sub Total
NYS residents must include sales tax at rate for the County where the items are being shipped.	Tax
	Total

**Credit Card information**
M/C ___ Visa ___	Expiration Mo/Yr. _____/_____	Security (CVC) #: _______
Account #: ________-________-________-________
Signature :______________________________________________________________

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