Name_______________________                           Date_____________

Address_____________________                           Phone____________

            _____________________                            Email____________

Qty            #                            Item                    Price               Total

____          _________               ___________________            ________            __________ 

____           _________              ___________________           ________             __________

____           _________              ___________________            ________             __________ 

____           _________               ___________________            ________            __________ 

____           _________               ___________________            ________            __________ 

                                                                                                Subtotal      _________

                                                                              PA tax 6%     _________

                                                               Shipping & Handling     _________

Visa Mastercard Information:                                Total cost     _________                                                                     

Name on card  ________________________  Exp date _________

Credit card # ________________________  Last 3 #'s on back______

Mail form to:   Stencil 'N Stitch     PO Box 291    Tannersville, PA 18372