Directions:

1. Fill out form completely.

2. Print 2 completed copies of the form. (keep one for your records)

3. Gather required number of freshly laundered shirts.

4. Pack shirts, one completed form, and $50.00 deposit in a sturdy box.

5. Mail to:   REgnA's Bloom
                  Angellina Ribordy
                   7812 S. 98th St.
                   LaVista, NE 68128

6. You will be contacted by email when your shirts have arrived.

*  Required Fields

* First name
* Last name
*Street address
Address (cont.)
* City
*State
* Zip
*Country
Phone
Cell
* E-mail

Pick your size of quilt:

Mini Throw           9 Shirts           $100

Throw            10-12 Shirts            $125

Twin              16-20 Shirts             $175

Full/Double    25-30 Shirts            $225

Queen             36 Shirts                 $300

King                42 Shirts                 $375

Type of Sashing:  

   Standard  (one color)  Select a Color Royal Blue Navy Blue Light Blue Black White Red Off White/Natural Light Grey Dark Grey Dark Green Light Green Purple Orange Pink Yellow Brown
Straight Set       Off-Set

   Window Pane  (additional charge of $30 per quilt)  0 colors 2 colors 3 colors 4 colors   Select a Color Royal Blue Navy Blue Light Blue Black White Red Off White/Natural Light Grey Dark Grey Dark Green Light Green Purple Orange Pink Yellow Brown
                                                                                                              Select a Color Royal Blue Navy Blue Light Blue Black White Red Off White/Natural Light Grey Dark Grey Dark Green Light Green Purple Orange Pink Yellow Brown     
                                                                                                              Select a Color Royal Blue Navy Blue Light Blue Black White Red Off White/Natural Light Grey Dark Grey Dark Green Light Green Purple Orange Pink Yellow Brown     
                                                                                                          Select a Color Royal Blue Navy Blue Light Blue Black White Red Off White/Natural Light Grey Dark Grey Dark Green Light Green Purple Orange Pink Yellow Brown

Picture Frame (additional charge of $30 per quilt) (one color) Select a Color Royal Blue Navy Blue Light Blue Black White Red Off White/Natural Light Grey Dark Grey Dark Green Light Green Purple Orange Pink Yellow Brown
Color for sashing Select a Color Royal Blue Navy Blue Light Blue Black White Red Off White/Natural Light Grey Dark Grey Dark Green Light Green Purple Orange Pink Yellow Brown

Pick your color for the back of the quilt:  Black Navy Blue White Sage Green Off White Yellow Cottage Blue Tan Burgandy

Pick type of batting:  Standard      Extra Loft (additional charge of $30 per quilt)

Shipping and Handling:  Standard mail ($18)   Express (2 day) ($30.00) 

Extras:

Photo Transfers: (optional) $4.00 per transfer
_______ X  $4.00 = _____
(number of transfers)

Personalization: (optional) Additional charge of $25 per quilt

Signature __________________________         Date _________________
By signing this order form, you agree to pay the $50.00 deposit and the remainder of the balance upon delivery of quilt.