Colorado Quilting Company - The PatternGrid® (Order Form)

The PatternGrid®, the PatternGrid® Jr, and/or the Piece O'Grid
Colorado Quilting Company, LLC
36159 Winchester Rd.
Elizabeth, CO 80107
(303) 646-9569
dvquilter@aol.com
www.coloradoquiltingcompany.com

Fill in the form below; print and mail it with your check, money order, or credit card information to the above address. Colorado residents add 3.9% sales tax. Do not send cash. Make checks payable to Colorado Quilting Company. Please note: If your computer is not protected by a firewall, we recommend that you print the form before filling in any personal or credit card information.

Shipping Information

Name:

Address:

City: State: Zip:

Phone –Home: Work:

Fax: Email address:

PatternGrid® quantity ordered: at $74.95 each	$
PatternGrid® Jr. quantity ordered: at $59.95 each	$
Piece O'Grid quantity ordered: at $19.95 each	$

Sub-Total:	$
Sales tax, if applicable: (Colo residents add 3.9%) %	$
Shipping and Handling:
PatternGrid® or PatternGrid Jr® tubes at $12.95 each	$
Piece O'Grid tubes at $7.95 each	$
(USA only - international orders please contact us for S&H costs.)

Total Due:	$

Credit Card Authorization Same as Shipping Information

Billing Name:

Billing address:

City: State: Zip:

Phone: Email address:

Card # Exp. Date:

3 digit number on back of card: Signature: