Print-able Order form

PRINT THIS ORDER FORM AND MAIL WITH PAYMENT INFORMATION TO: Country Stitches P.O. Box 145 Polk City, Iowa United States 50226 Phone #: 712-732-5419 Fax #: 712-732-5419 Email: order@countrystitchesonline.com
Circle Payment Method: Check Money Order VISA MasterCard
Print Name:
Address:	Email:
City:	Credit Card Number:
State & Zip:	Expires:
Telephone:	Signature:_____________________

Item Name and Description	Quantity	Price














Subtotal:
Shipping and Handling:
Iowa residents must add 5% sales tax-
MAKE CHECKS PAYABLE TO: Country Stitches	Total :

Thank you for shopping at Country Stitches.