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Order Form
 
Name: __________________________________________
 
Address:_________________________________
 
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?
 
____________________________________________________
 
Email:
 
Call:
(412) 759-8411
 and we will schedule an appointment
to discuss your project.
           
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