Intake form for T-Shirt quilts

T-Shirt Order Form

PRINT AND MAIL WITH YOUR T-SHIRTS

Marlene Steimel

14135 Keslinger Rd.

DeKalb IL 60115-8854

msteimelquilts@gmail.com

Name: ___________________________________________________________________

Street Address __________________________________________

City __________________________________ State ________ Zip Code ______________

☐ Residential Address ☐ Business Address

Phone # __________________________ E-Mail Address __________________________

*We do not ship to PO Boxes – please provide physical shipping address. *We do ship to Military FPO AP Boxes

Return shipping - would you like to have to sign for the box? Yes No

Desired Quilt Size:

☐Lap ☐Large Lap ☐Multi Use ☐Twin ☐Full ☐Queen ☐King ☐Whatever size the shirts make

Backing & Binding Colors:

Backing Color:______________________ Binding Color: _________________________ ☐ Help – give me some suggestions!

Borders: A border increases the overall size and price of the quilt.

☐ 2" Solid ☐ 4" Solid ☐ 6" Solid ☐ 8" Solid ☐ 12" Solid

 ☐4" pieced

☐4" solid outer + 2" solid inner ☐ 4" pieced + 2" inner

☐4" pieced + 2" inner & 2" outer ☐ Unsure

Color or colors for border ________________________________________________________________________

Must have quilt back by? _____________________________ ☐ Whenever is fine

Who is the quilt for? ☐Male ☐Female

Is the quilt a surprise? ☐Yes ☐No If yes, can we contact you via e-mail? ☐Yes

☐No

Do you have a code word we can use if we need to call you? ____________________________________________

May we use a photograph of your quilt on our web site? ☐Yes ☐No

Payment: Please choose a method of payment from the options below.

☐Check or Money Order or cash when the quilt is completed

Make checks payable to Marlene Steimel