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For those of you who are still hesitant to use a secure web site to enter credit card information, you may print this page,
complete the information and mail your order and payment as instructed below.  It will take 2 pages to print.
Thank you.

RETAIL ORDER FORM

Item # Description Size / Color Price Quantity Total
   
 		        
    
 		        
    
  		        
    
  		        
    
  		        
    
  		        
    
  		        
    
  		        
    
  		        
    
  		        
Shipping / Handling *

   $   2.00
Sub-Total    $
Washington State Residents add 7.6%
Sales Tax		    $
Total Due    $

* Shipping / Handling:
To US & Canadian addresses:  Add $2.00 to all orders.
To addresses outside the US & Canada:  Add $11.95 to all orders.

Name: ______________________________________________________
Mailing Address: ______________________________________________________
City, State, Zip ______________________________________________________
Delivery Address:
if different		 ______________________________________________________
City, State, Zip ______________________________________________________
Telephone: _____________________________________
E-mail: _____________________________________

Credit Card Payment:

Type of Credit Card: VISA          MasterCard         American Express
Credit Card Number: _____________________________________________________________
Expiration Date: _____________________________ 3-digit security code ______________
Signature: ______________________________________________________________

Mail this form & your payment to:

PACIFIC RIM QUILT COMPANY
P.O. Box 932
Snohomish, WA 98291-0932

Our e-mail address is: janice@prqc.com

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