Order Form

Wrapped Up In Memories Order Form

Your Name

Your Street Address

Your City

Your State

Your Zip

Residential or Business address? (mark one)

Do you want to make sure you have to sign for your quilt when it is delivered? (mark one)

Your Phone Number (Cell phone preferred. If no cell provide home phone)

Does your cell phone receive text and pictures? (mark one)

Your Email

Quilt Size or Memory Pillow (mark one)
(3 pieces of clothing required per pillow unless you request a pillow from one piece of clothing only)

What color binding? (this goes around the edges of the quilt)

What color backing?
The colors below are in stock and is included in the price. If you want another color/fabric, you will need to provide it.

Do you want a particular shirt in the center? (please describe the shirt and mark it with tape)

Due Date:

Who is this quilt or pillow for?

Payment Method:

Special Instructions:

A $50 deposit will be due at the time of shirt delivery. The remaining balance is due at the time of quilt completion. If you are out of town, I will send you a finished picture of your quilt and wait for your final payment before sending it to you.