First Window Size

Item Total

Shade Model 400, White Tracks Model 400, Brown Tracks Model 100, White Tracks Model 100, Brown Tracks

Fabric Ecru Newport Light Filtering Ecru Newport Room Darkening   Width in  Length in  Quantity

$

Second Window Size

Item Total

Fabric Ecru Newport Light Filtering Ecru Newport Room Darkening   Width in  Length in  Quantity

$

Third Window Size

Item Total

Fabric Ecru Newport Light Filtering Ecru Newport Room Darkening   Width in  Length in  Quantity

$

Fourth Window Size

Item Total

Fabric Ecru Newport Light Filtering Ecru Newport Room Darkening   Width in  Length in  Quantity

$

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

+ $30 S&H ea. (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 10/2014 11/2014 12/2014

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)

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

  (Secure Transaction)

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