SNAIL MAIL ORDER FORM
Name:

OregonPatchWorks, Inc.

Address:

PO BOX 333

MAPLETON, ORE. 97453

Phone: USA:  1-888-Lov2Sew (1-888-568-2739)

International:  1-541-359-0879

Email:

support@oregonpatchworks.com

PRINT THE FORM, FILL OUT ALL NECESSARY INFORMATION AND MAIL TO ADDRESS ABOVE.  PLEASE PRINT CLEARLY.
: TODAY'S DATE:

METHOD OF PAYMENT:     (CHECK MARK ONE)

PERSONAL CHECK

MONEY ORDER

 CREDIT CARD

METHOD OF DELIVERY:   (EMBROIDERY DESIGNS)

DOWNLOADS (NO FEE)

SHIPPED CD (FEE APPLIES*)
YOUR NAME::

SHIPPING ADDRESS:

CITY:

STATE:

ZIP:

 COUNTRY:

EMAIL ADDRESS:

TELEPHONE:

 
CREDIT CARD USERS::
FULL NAME ON CARD:
TYPE OF CREDIT CARD: ACCT #:
EXPIRATION DATE: CVV2 (LAST 3 DIGITS ON BACK OF CARD):

BILLING ADDRESS IF DIFFERENT:

COMMENTS:

Item # Product Name Format  Each Total
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
*PERSONALIZED, CUSTOM CD OF ALL YOUR DESIGNS - USA:  ADD $11   INTERNATIONAL:  ADD $18
 FEE INCLUDES S/H, UP TO 15 SETS PER EACH CD, ALLOW UP TO 4 WEEKS DELIVERY TIME
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