"Classic Candlewick Quilt" Application Form

Name:________________________

Phone (H) :______________________   Email:__________________________

Address:______________________

 

Phone (W) :______________________
   
Postcode:_____________________ Mobile:______________________    

Please enrol me in "Classic Candlewick Quilt" Block a Month:.

Block Patterns 1 Year Aus$120 (Full payment includes postage) __________________________
  4 Months Aus$40.00 (Includes postage) __________________________
I understand that two further payments of Aus$40.00 are due on 10/8/04
and 30/11/04
An account will be sent with the posting on these dates.

 

         
           
   
  Quilt Kit (Please indicate: TRADITIONAL CREAM or PASTELS)   ___________  
      ___________  
  ___ Mtrs Seeded Homespun   ___________  
  ___ Balls Candlewicking Thread
* (Please indicate colours)
(Colours include: Apricot (_
), Light Pink (_) Dusty Pink (_)
Light Blue
(_) Pale Blue (_), Sage Green (_) Pale Green (_)
Lemon
(_), Dull Yellow (_), Mauve (_), White (_), Cream (_)
  ___________  
  ___ Heat Transfer Pencil   ___________  
  ___ Sheets Transfer Paper   ___________  
  ___ Packs Needles   ___________  
 

Postage & Packaging:(up to $5.00 within Australia)
Overseas Package actual charges added to total

  ___________  
  (Please do not include "Block Patterns amount when calculating postage)
  International Postage actual charges added to total.
 
Total
Aus
$___________
 

Payment options

Please deduct Aus$__________ from my:

Mastercard Bankcard Visa
Please accept my cheque for Aus$___________

Cardholder Name:_______________________________________

Card number: _ _ _ _/_ _ _ _ /_ _ _ _ /_ _ _ _

Expiry Date: _ _ /_ _

Signature_____________________________________________