CUSTOM/SPECIAL ORDER FORM

 

Mail to:

 

Embroidery By Hand

79 Tolland Stage Road

Tolland, CT 06084

 

Ship to:

 

Date: _______________

 

Name: _____________________________________________________________

 

Address: ___________________________________________________________

 

City, State, ZIPCode: _________________________________________________

 

Telephone No. __________-__________-____________________________

 

QTY	Item #	Description/Colors	Unit Price	Total Price

 

Check method of payment □ Check or M.O. enclosed □ Payment by PayPal   DO NOT SEND CASH   Subtotal
Sales Tax (CT sales)
S&H (48 contiguous states only)	FREE
Total

 

 

 

Special instructions:

______________________________________________________________________

______________________________________________________________________
___________________________________________________________________
_____________________________________________________________________
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Purchaser: _____________________________________ Date: __________

                                                Please sign & Date