Wagner's Quilts and Conversation
Printable Order Form
Please print this form for easy mail order.
Complete your order, send along with your check, money
order (USD only), or Credit Card info to:

Wagner's Quilts and Conversation
PO Box 418
Arapahoe, NE  68922
wagnersquilts@atcjet.net

Qty.

Item

Price

Total

 

 

$

$

 

 

$

$

 

 

$

$

 

 

$

$

 

 

$

$

 

 

$

$

 

 

$

$

Domestic Shipping:
up to $10.00.....$5.99
$10.01-$30.00.....$7.99 
$30.01-$80.00.....$10.99
$80.01-$120.00.....$13.99
$120.01-$200.00.....$20.00
Canadian orders include an additional $15.00 to above rates. 

Shipping/Handling

$

Total Order

 

CREDIT CARD INFORMATION

Name on Card-

Card Number-

Exp. Date-                                                                           CIRCLE ONE:  VISA    M/C    DISCOVER

CUSTOMER INFORMATION

Customer Name

Address

City                                                                                      State                                Zip Code

Home Phone #                                  Work Phone #                              Email Address