Order Form
Name: __________________________________________
City, State and Zip _________________________
Phone Number: ___________________________
Email: __________________________________
Order Request:
Date: _________

Modern Keepsakes Quilt: _______________________

Sashing (Fabric Framing around T-shirts)  yes ... no

Fabric  Keepsakes Box: ____________________

Bed Head Pillowcase: ______________________
Color Request: ___________________________
Specifications of Payment
50% due at the time of order, the remaining balance due upon receipt of completed project.

Additional Comments and Instructions:
How did you find out about
Modern Keepsakes by Renee?
(412) 759-8411
 and we will schedule an appointment
to discuss your project.
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