Wagner's Quilts and Conversation
Printable Order Form
Please print this form for easy mail order.
Complete your order, send along with your check, money
order (USD only), or Credit Card info to:
Wagner's Quilts and Conversation
PO Box 418
Arapahoe, NE  68922
wagnersquilts@live.com

Qty.	Item	Price	Total
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
Domestic Shipping: up to $10.00.....$2.99 $10.01-$30.00.....$4.99  $30.01-$50.00.....$6.99 $50.01-$80.00.....$10.99 $80.01-$100.00.....$12.99 Canadian orders include an additional $9.00 to above rates.		Shipping/Handling	$
		Total Order
CREDIT CARD INFORMATION
Name on Card-
Card Number-
Exp. Date-                                                                           CIRCLE ONE:  VISA    M/C    DISCOVER
CUSTOMER INFORMATION
Customer Name
Address
City                                                                                      State                                Zip Code
Home Phone #                                  Work Phone #                              Email Address