Print this form, fill out all the information and send to:
Ornamental Appliqué
Jenifer Buechel
6496 Simmons Ave.
South Park, PA 15129

or fax to:
1.412.835.5403

If you cannot print and order form please use a piece of paper and include all of the necessary information. 

Make checks payable to:
Jenifer Buechel
Please do not send cash or e-mail credit card numbers!

Wholesale inquiries welcome

Ship to:

Name  
Street  
Street  
City, State. Zip  
Phone No. (             )
E-mail  

Phone and E-mail are only for questions about your order.

Credit Card Information- please check one

 Visa
MasterCard

Check for authorization to bill monthly-
Block of the Month only!

Account Number-
Expiration date-

Order Form

Quantity

Description
 (always specify pattern name and number)

Price

Total
       
       
       
       
       
       
       
       

Shipping and Handling Cost

Single Pattern Only $ 0.85
Multiple Patterns: Shipping Cost
$0.00- $20.00 $2.00
$20.01- $50.00 $4.50
$50.01- $100.00 $5.50
$100.00 and up $9.00
Subtotal  
7 % Sales Tax (Pa Residents)  
Shipping and Handling  
Additional Shipping Charges  
Total Due