Order Form

For our customers who prefer not to place credit card orders online, you can complete this order form, print it, and mail or fax it with your ordering and payment information. Please complete the form below and print it on your printer.

Name, First and Last:
Street Address:
City:
State:	Zip Code:
Email Address:
Order:
Item Description (include size & color)	Item Price x	Qty	Price
Item 1:	$	#	$
Item 2:	$	#	$
Item 3:	$	#	$
Item 4:	$	#	$
Item 5:	$	#	$
Shipping (See chart below)			$
SUBTOTAL			$
Tax (If Wisconsin Resident)	(subtotal x .055)		$
All items are shipped U.P.S.	TOTAL
1 - 3 items ..... $9.00 shipping 4 items ... $10.00 5 items ... $11.00 6 items ... $12.00 7 items ... $13.00

PAYMENT INFORMATION
Check is enclosed ___
Name on Credit Card
Type of Credit Card	Mastercard Visa Discover
Number on Credit Card
Expiration Date on Card	month _____ year ________
Questions/Comments:

You can print this form and mail it to:
B&B Embroidery, 4017 Windsor Rd., DeForest, WI 53532
or fax it to B&B Embroidery at (608) 846-7113