P.O. Box 21833 - Upper Arlington, OH 43221 - 614-481-0017

ORDER FORM
(Please Type or Print in Black Ink)
Order form must be filled out completely!

DATE:
Ship To:
Address:

 

 

Tel:
Fax:
E-Mail:

Payment With Order Only
(If you are paying by check, your order will be
shipped once it has cleared the bank.)
Checks payable to
Fanci That Patterns, Inc.

If paying by credit card,
please see instructions below.

Ohio Residents
pay 5.75% sales tax

Qty

Item Name/Description

Price Ea.

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sub Total

 

Ohio Residents - add 5.75% sales tax

 

Shipping/Handling add - $3.00

 

Prepaid

 

Total Amount Due

 


If you are paying by credit card, please enter the information below
Please be sure your name/address match that on your credit card.

¨Visa
¨Mastercard
¨Check Enclosed

Card Number:

Expiration Date:

Name as It Appears on Card:

Signature: