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Name__________________________________________________________________
Address_________________________________________________________________
City____________________________________State_____________Zip_____________
Phone
( )_____________________Referred
By:______________________________
Email
Address:___________________________________________________
Discover/Mastercard/Visa#
_________-________-________- ________
Expiration
Date:_______________Have you ordered before?__________________
Thank
you for ordering a custom patch through Patchwork Designs. A graphic
image will be sent to you upon receipt of this order form.
The
pricing below does not include patches larger than
3 inches, 100% embroidered, satin twill, or metallic threads.
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