1)  Shape of Patch : _______________________________

2)  Size of Patch : ________________________________

3)  Quantity needed (minimum order of 50) : _____________________________

4)  Background type (circle one) : Twill or 100% embroidered

5)  Color of Background : Choose your color from the twill chart __________________________

6)  Color of outside trim : Choose your color from the thread chart___________________________

7)  Details and their colors:  You are allowed to choose 9 colors, one which is your outside trim.

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

8)  Type of backing -  (choose one)     PVC (usual choice)        Iron-On          Self-Adhesive
PVC is the default choice. Self-Adhesive and Iron On require a slight increase in price

9)  Delivery Date needed:____________________________________________________________
Project will arrive 3-4 weeks after the completed sales agreement

10) Exact Lettering and color of lettering_________________________________________________

11) Budget price per patch $_____________

12) Contact information:

Name:_________________________________________________

Address:________________________________________________

City___________________________________ State_______ Zip__________

Phone____________________________________ Email Address:__________________________

Please fax, email, or mail the completed form and design or idea.

Fax:     (703) 743-9942

Mail:    
Patchwork Designs, Inc.
8421 Churchside Drive
Gainesville, VA 20155

Questions:
Email: cheryle@patchworkdesigns.net
Phone: (703) 743-9948

***All custom items need to be paid in full prior to shipment.
If you have a credit card on file, we will charge this card unless otherwise noted on your file to do otherwise.