blanket_order

Quilt Square Mail Order Form

Red Thread Embroidery

This form can be filled in with your PC and then printed

1. Shipping Information:

First Name

Last Name

Address

City

State

ZIP Code

Phone

(in case we need to contact you about your order)

Email Address:

Verify Email:

Personalized Quilt Square Information

2. Chinese Name Pinyin:

Quilt Square #1:

Surname (1st Symbol)

Middle (2nd Symbol)

Last (3rd Symbol)

Thread Color

Quilt Square #2:

Thread Color

Important: Please email or snail mail clear copies of the Chinese symbols to us. Include your name, order date and pinyin for each symbol.

3. First Name:

Quilt Square #1:

Quilt Square #2:

Thread color will be the same as for the symbols chosen above

Order subtotal:

Shipping:

Order Total:

4. Print this completed form and mail, along with your Chinese symbols with pinyin and personal check (made out to A. Versluis) to RTE at the address below. You can pay via PayPal by emailing the funds...please email us if you prefer this method.

Red Thread Embroidery

POB 753

Bentonville, AR 72712

Questions about the ordering process? Email us

Privacy Note:

The information submitted on this page will only be used to process your order.

RTE will not share customer information with anyone.

Surname (1st Symbol)

Middle (2nd Symbol)

Last (3rd Symbol)

Personalized request:

Thread Color

All quilt squares will say "100 Good Wishes For" and then the Child's name unless otherwise requested