PLEASE NOTE! This is an order form for paying by Postal Mail. Make check or money order out to: Country Quilts and Fabric. Please print out the form, fill it in and send it to: Country Quilts and Fabric PO Box 606 Kimball, NE 69145 Phone: (308) 235-2717 Want to charge it? Give us a call! Phone: (308) 235-2717 Item Code Description, size, color Quantity Price Each Total Price       $ $       $ $       $ $       $ $       $ $       $ $                               SHIPPING OPTIONS AND RATES: $0 to $39.99 add $6.00 $40.00 to $54.99 add $7.00 $55.00 to $64.99 add $8.00 $65.00 to $74.99 add $9.00 $75.00 to $99.99 add $10.00 $100.00 to $199.99 add $11.00 $200.00 to $299.99 add $14.00 $300.00 and over add $17.00 Subtotal $ < < < Shipping $ Grand Total $ SHIP TO: Name:___________________________________________________________________ STREET Address:_________________________________________________________ City:_______________________________________State/Province:________________ Zip/Postal Code:_________________Phone:___________________________________ E-mail Address:___________________________________________________________

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