Order Form
(Please Print)		 Calico Annie's Quilt Shop
210 Broadway
P.O. Box 661
Fullerton, NE 68638
Telephone: 308-536-2925
calicoannie@qwestoffice.net
Mailing Address:
Name:
Address:                                                                      Apt:
City:                                   State:                     Zip:
Phone:                                                             Email:

Payment Method: (Check One) US DOLLARS ONLY

___ Check                 ___ Money Order                   ___ Credit Card
Card Number:  _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Exp. Date:
Name on Card:  

All Sales are Final

Item Description Price Qty Amount
       
       
       
       
       
       
       
       
       
       
       

Total

  

Domestic Shipping & Handling 15% of Order Total ($16 MAX) International orders will have applicable shipping charges added

  

    Sub Total

  

NE residents add 6.5% sales tax

  

Total