Order Form
(PLEASE PRINT OUT AND FAX)
E-mail: hqfs@centurytel.net
Heritage Quilts & Fabric Shoppe
PO BOX 1517 Pinedale WY 82941
307-367-7397 (fax) between 9:00am-5:30pm
Monday -Saturday
Name:_________________________________________________
Address:_______________________________________________
______________________________________________________
Phone:________________________________________________
Credit Card Information
Credit Card Number:______________________________________
Expiration Date:_________________________________________
Item # Description
QuantityPrice
QuantityPrice______________________________________________ ______________$____________
_________________________________ ______________$__________________________________________________________ ______________$____________
_________________________________ ______________$__________________________________________________________ ______________$____________
_________________________________ ______________$__________________________________________________________ ______________$____________
_________________________________ ______________$__________________________________________________________ ______________$____________
_________________________________ ______________$__________________________________________________________ ______________$____________
_________________________________ ______________$____________Sub Total:____________________
Shipping Charges:____________________
Sales Tax For Wyoming Customers Only (4%):____________________
TOTAL:____________________
SHIPPING CHARGES
Order Total Shipping & Handling
Zero to $19.99 +$5.25
$20.00 to $39.99 +$7.35
$40.00 to $69.99 +$9.50
$70.00 to $99.99 +$12.00
$100.00 to $200.00 +$14.00
$200.00 to $250.00 +$18.00
$250.00 ON UP FREE
FREE
