BILL TO:

.NAME:__________________________

ADDRESS:_______________________

ADDRESS LINE 2:_________________

CITY:___________________________

STATE:__________________________

ZIP CODE:________________________

SHIP TO:

.NAME:__________________________

ADDRESS:_______________________

ADDRESS LINE 2:_________________

CITY:___________________________

STATE:_________________________

ZIP CODE:______________________

PATTERN NUMBER      QUANTITY      DESCRIPTION           PRICE          TOTAL

SHIPPING CHARGES:

$2.00 FOR FIRST PATTERN

ADD $.75 FOR EACH ADDITIONAL PATTERN

TOTAL WITHOUT SHIPPING:______

TOTAL WITH SHIPPING:________

Please allow up to two weeks for your check to clear. 

Mail your check or money order and make payable to:

Leldon Maxcy

974 County Road 1422

Cullman, Alabama 35058