Electronic Order Form

Required Information
Type of Charge Card:		Select Card Visa MastercardDiscover
Name on Card:
Billing Address:
City:		State: Zip:
Card Number:
Card Expiration Date:
E-mail:		Area Code: Telephone:
Shipping Information
Name to ship product to:
Address Line 1:
Address Line 2 (optional):
City:		State: Zip:
Special Shipping Instructions (optional)

Select products from the menu below.
A Quilter's Legacy Products
A Quilter's Legacy Journal	Qty: None 1 2 3 4 5 6 x $17.95 (ea) =
Sukura Pigma Pen (Black permanent waterproof ink)	Qty: none 1 2 3 4 5 x $ 3.75 (ea) =
Sukura Pigma Pen (Blue permanent waterproof ink)	Qty: none 1 2 3 4 5 x $ 3.75 (ea) =
Sukura Pigma Pen (Red permanent waterproof ink)	Qty: none 1 2 3 4 5 x $ 3.75 (ea) =
Sukura Pigma Pen Set (Blue, Red, Green, Purple, Black, Brown)	Qty: none 1 2 3 4 5 x $16.00 (pkg) =
Sukura Calligraphy Pen Set (Blue, Red, Green, Purple, Black, Brown)	Qty: none 1 2 3 4 5 x $16.00 (pkg) =
Photo Mounting Tabs (400/pkg)	Qty: none 1 2 3 4 5 x $ 4.50 (pkg) =
Photo Adhesive Tape (Acid free)	Qty: none 1 2 3 4 5 x $ 7.00 (roll) =
Sub-Total:
Shipping (U.S. residents): with 1 journal is $5.00 (Additional journals add $1.50 each) International Shipping may vary:
Sales Tax (8.25% Texas orders):
Total:
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