Quilt Valley |
771 N Seneca Rd |
| Name: ______________________________ | |||
| Address: ____________________________ | |||
| City: __________________ | State: _____ | Zip: ____________ | |
| Ship to: (If different from above) | |||
| Name: ______________________________ | |||
| Address: ____________________________ | |||
| City: __________________ | State: _____ | Zip: ____________ | |
| Please provide the following in case we need to contact you about your order. | |||
| Email: _________________________ | |||
| Item Number (See website for item #) |
Item Name (See website for item name) |
Size | How Many | Price/Item | Total Price | |
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Total
for Merchandise:
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For
Delivery in Kansas, Add 5.3% Sales Tax
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Shipping
Charge:
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Grand
Total:
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Method of Payment (Check One): Check Money Order We cannot process credit card orders on mail in orders at this time. Allow 10 additional days processing for personal checks. |
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