Darlenes Embroidery World Order Form
Darlene Clair
428 East Patterson Ave.
Bellefontaine, OH 43311
Phone: (937) 599-2049
Please read and print "Ordering Information" before filling out
this form!
PLEASE PRINT ALL INFORMATION CLEARLY
Name:_________________________________________
Date:________________
Address:__________________________________________________________
City:______________________________________State:_____
Zip:__________
E-mail Address: ___________________________Tel.
No:__________________
Method of Payment: [ ]Check/Money Order
*Check must clear before designs are sent
Qty Description Price Total
____ Herbs (7 designs) 7.00 ________
____ Funny Fruit (10 designs) 10.00 ________
____ Fruit and more (10 designs) 10.00 ________
____ Christmas (30 designs) 30.00 ________
Please circle one
xxx exp dst csd hus pcs pes sew
Merchandise Total: ________
Shipping/Handling (USA & Canada only): 3.00
*Shipping/Handling free if the designs sent by e_mail 0.00
Subtotal: ________
Total Due: ________
Please fill out form and send to:
Darlene Clair
428 East Patterson Ave.
Bellefontaine, OH 43311
[email protected]