Elegant Counterpanes
406 Thunderbay Drive - Georgetown, Texas 78626
Print and complete this order form and mail, with deposit, to above address.
Date:
Your email address: ______________________________
Phone Number (required if no current email address): _________________________
Shipping Address
Name:___________________________________________________________________
Address:_________________________________________________________________
City/State/Zip_____________________________________________________________
Phone number (optional):_________
If this is a gift address, date needed to be delivered by:_____
Billing Address
Name:___________________________________
Address:_________________________________
City/State/Zip:_____________________________
Wholecloth Heirloom Quilt Order Form
Quilt Size
Pattern Name
Fabric Color
Thread Color
Deposit Amount
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Total Deposit $
You will receive confirmation by email/mail noting that your deposit has been received and the approximate date of
completion. When the quilt is completed you will be notified by email/mail with the balance due. Once that is received,
your quilt will be shipped.
Note: All initial deposits are non-refundable. See policies for complete details.
Signature to accept above terms ____________________________________________________
Check # or Money Order ______________ Amount enclosed $__________________
