SNAIL MAIL ORDER FORM
OREGONPATCHWORKS INC.
5075 ROYAL AVENUE

EUGENE, OREGON 97402

USA TOLL FREE 888-568-2739
INTERNATIONAL 541-359-0879

FAX 503-914-6657

PRINT THIS FORM, FILL OUT ALL NECESSARY INFORMATION AND MAIL IT TO ADDRESS ABOVE. 
PLEASE PRINT CLEARLY!!
TODAY'S DATE:
METHOD OF PAYMENT (CIRCLE ONE):
PERSONAL CHECK
MONEY ORDER
CREDIT CARD
METHOD OF DELIVERY (CIRCLE ONE):
DOWNLOADS (NO FEE)
SHIPPED CD (FEE)
SHIPPED ZIP (FEE)
YOUR NAME::
SHIPPING ADDRESS:
CITY:
STATE:
ZIP CODE:
COUNTRY:
EMAIL ADDRESS:
TELEPHONE:
CREDIT CARD USERS - FULL NAME ON CARD:
ACCT #:
TYPE OF CREDIT CARD:
EXPIRATION DATE:
3 DIGITS ON BACK OF CARD:
BILLING ADDRESS IF DIFFERENT:
COMMENTS:
 
 
ITEMCODE # PRODUCT NAME FORMAT EACH AMOUNT
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
* GET UP TO 15 COLLECTIONS PER CD = USA:  ADD $12.95   INTERNATIONAL:  ADD $21.95
 

* GET UP TO 15 COLLECTIONS PER ZIP DRIVE - USA:  ADD $14.95   INTERNATIONAL:  ADD $24.95

 
THANK YOU FOR SHOPPING WITH US! Subtotal  
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