Today's Date: Please Fax or Mail Order Form to:
Old Time Patterns
P.O. Box 1395
Kill Devil Hills, NC  27948
Phone:  252-255-8009
Fax:  252-480-2421
Email:  sales@oldtimepatterns.com
Customer Name:
Billing Address:
City  
State  Zip Code 
Day Phone:
Evening Phone: 		Shipping Address (if different):
Name:

Street Address:
City 
State Zip Code 
Item # Description Size (if applicable) Quantity Price Each Total Price
           
           
           
           
           
           
           
           
           
           
Shipping Charges:
Within the US - $4.75 for orders (subtotal) under $50
                         FREE for order over $50
Canada/Mexico - $10.25 for orders under $100
                            FREE for orders over $150
Everywhere Else - $12.25 for orders under $100
                             FREE for orders over $150		 Subtotal
<<<     Shipping Charge
Sales Tax (NC add 7.75%)
Total
Please include total payment with order. Personal Checks and Money Orders are accepted. Personal Checks will be held up to 14 days to clear the bank.

Please make checks or money orders
payable to Pier Pleasure.

If paying by Credit Card, please complete the following:
We accept MasterCard, Visa, American Express and Discover Card.
Credit Card #
Expiration Date (MM/YY) 
CV Code on back signature line

Signature ____________________________________________