KS fabric arts Order Form for Memory Quilts

CUSTOMER INFORMATION
Name
Address
city, State and Zip Code
Phone Number (include area code)
e-mail
SHIPPING INFORMATION (if different than of above)
Name
Address
city, State and Zip Code
PAYMENT INFORMATION

Payment is due when you place your order, however, will not be processed until your quilt is complete (just prior to shipping).
Payment amount: $__________________
______ check or Money Order made out to Kay Soyka
______ Credit Card: _____MasterCard _____Visa _____American Express
Account Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Security Code (the last 3 or 4 digits on back of your card: __ __ __ __
Expiration Date: __ __ / __ __
Name as it appears on card (please print): ___________________________________________
Signature: ___________________________________________________________________________

SQUARE PLACEMENT

Indicate below how you wish the novelty squares to be arranged in your quilt. Jot down a brief description for only the number of squares that apply; add more squares on back if needed.
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Payment is non-refundable once construction of the quilt has begun. Please contact us if you have any questions at (586) 323-9655 or e-mail kaysoyka@gmail.com
Enclose this order form with your payment and materials and mail to:
KS fabric Arts
47832 Robin Street
Shelby Township, MI 48317