Billing Information:

Full name:

Street Address:

Apt. # or Suite #:

City, State, Zip:

Country:

Phone:

e-Mail:

Shipping Address (Please complete if different from billing address:

Is this a gift?

Full name:

Street Address:

Apt. # or Suite #:

City, State, Zip:

Country:

Phone:

e-Mail:

Order Info: Please be sure to provide vendor's name and description of item so we can expedite your order.

Vendor's Name

Item Number/Description

Qty.

Price Each

Total Price

If you are ordering a needlepoint canvas and would like us to supply the floss, please let us know your preferences:

Please note that all sales are final and your credit card will not be charged until your order is shipped. Applicable taxes and shipping charges will be added to your invoice. Unless otherwise requested, your order will be shipped via US Priority Mail. We will send you a confirmation of your order via e-mail along with a tracking number when the order is shipped.

MasterCard or VISA card number:

Exp. Date:

Name on Card: