First Window Size

Item Total

$

Second Window Size

Item Total

$

Third Window Size

Item Total

$

Fourth Window Size

Item Total

$

State Sales Tax (Mass and VT residents)  MA 6.25% VT 6% (VT includes tax on shipping)

+ $12.95 S&H (All orders, Continental U.S. only)

Tax

Shipping

Total US

$

$

$

Visa  MC  Check

Card Number (no spaces)

Expiration   09/2009 10/2009 11/2009 12/2009 01/2010 02/2010 03/2010 04/2010 05/2010 06/2010 07/2010 08/2010 09/2010 10/2010 11/2010 12/2010 01/2011 02/2011 03/2011 04/2011 05/2011 06/2011 07/2011 08/2011 09/2011 10/2011 11/2011 12/2011 01/2012 02/2012 03/2012 04/2012 05/2012 06/2012 07/2012 08/2012 09/2012 10/2012 11/2012 12/2012 01/2013 02/2013 03/2013 04/2013 05/2013 06/2013 07/2013 08/2013 09/2013 10/2013 11/2013 12/2013 01/2014 02/2014 03/2014 04/2014 05/2014 06/2014 07/2014 08/2014 09/2014

Security   what's this?

If paying by check, print out this form and send to:

Window Quilt, Inc.

22 Browne Ct. #105

Brattleboro, VT  05301

Billing Information (Complete all)

First Name..*

Last Name..*

Address1....

Address2...

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State/Prov...

Zip/PC........ USCAN

Email ...*

Phone..........

Customer acknowledges that Panels are not returnable for incorrect measurements.*

  (Secure Transaction)

Shipping Information (Leave blank if same.)

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Last Name...

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Address2.....

City....

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Zip/PC.. US CAN

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* Required to process order