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SPECIAL OCCASIONS Mail or Fax Order Form
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Please fill out completely: Date_________________
Name______________________________________________Phone_________________
SHIPPING ADDRESS
Name____________________________________________________________________
Address_________________________________________________________________
City_____________________________State__________________Zip_____________
Country_______________________________Phone_____________________________
EMail (optional)________________________________________________________
Method of Payment Check/Money Order _____ Master Card _____
Visa _____ Discover _____
American Express _____
Credit card Number ______________________________ Exp date ________
Cardholder Name _________________________________________________
Billing Address ______________________________ Zip _____________
Signature _________________________________________________
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Item Qty Price Total
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Special Occasion Items
How it works: 1 Select the items you want to order.
2 Fill out the order form.
3 Get this form to us by one of the following means:
4 Get your logo to us by one of the following means:
- Email to sales@EmbroideryCreations.com
- Fax to 937-235-0487 (include colors)
- Stop by our Huber Heights location 937-235-0441
- Mail info to: Embroidery Creations
5050 Nebraska Ave. Ste. 9
Huber Heights, OH 45424
5 Mail or fax this form to us (fax 937-235-0487)
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BIRTH CERTIFICATES
Boy (blue)_____ Girl (pink)_____
Name________________________________________________________________
Date _______________________________________________________________
Weight______________________________________________________________
Length______________________________________________________________
= _____ x 40.00 = _______
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AFGHAN (50" x 60") American made woven natural color
Heart Design_____ Waffle Design_____
Wedding Date Afghan Names_________________________________________
Date__________________________________________
Flowers_____ Bells_____ Church_____ Plain_____
Anniversary Afghan Names_________________________________________
Date__________________________________________
Flowers_____ Bells_____ Church_____ Plain_____
Birth Afghan Name__________________________________________
Date _________________________________________
Weight________________________________________
Length________________________________________
Boy (blue thread)_____ Girl (pink thread)_____
Family Name Name__________________________________________
Thread color__________________________________
Two Hearts Name____________________Name__________________
= _____ x 40.00 = _______
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BRIDE & GROOM HATS
Hats _____
Names (optional $5 each) Bride_______________ Groom_______________
= _____ x 20.00 = _______
names = _____ x 5.00 = _______
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Total number of items _____ Total________
Shipping =$5 for first item plus $1 per additional Shipping________
Subtotal ________
Tax (Ohio residents only 6.5%) ________
Total Order Amount ________
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