Rug Form

245 SW 132nd Terrace
Newberry, FL 32669
Tel (352) 331-2595

Please print out this order form and mail with payment to the address above.

Customer:		Ship to: (if different from customer address)
Name:____________________________		Name:____________________________
Address:__________________________		Address:__________________________
_________________________________		_________________________________
City: _____________________________		City: _____________________________
State: ______________ Zip: __________		State: ______________ Zip: __________
Telephone: ________________________		Telephone: ________________________

Item		Total









Please make checks or money orders payable to: Janet Patacca or Stitches In Miniature Please remit all funds in US dollars and allow 2-3 weeks for delivery. Shipping within the US is $5.00. Please call for overseas charges.	Subtotal
	Sales Tax (Florida deliveries add 6.25%)
	Shipping Charges	$5.00
	Total Enclosed