ORDER FORM
1275 Pheasant Avenue
Afton, IA 50830
Phone - (641) 347-8831
E-mail: buttonwe@mddc.com

You may print out this Order Form and MAIL your order. Orders can be E-mailed. If using E-mail, call with your credit card number.
Please DO NOT send electronically. This is not a secure line.

Name:
Address:
City: State: Zip:
Daytime Phone: Fax:
E-mail:
Payment Method: Check:____ Credit Card:____
Visa: MasterCard: Card Number:
Exp: Signature:
Quantity Description of Item Pattern # Item Price Amount
         
         
         
         
         
         
         
         
         
         
         
         
         
         

Please add Shipping Charges:
Patterns:                       
1 - 3  $1.00                    

4 - 6  $2.00

7 - 20 $4.80                                  

* For Shipments out of the US:
Please include your credit card number. You will be billed for the actual shipping charges plus the amount shown to the right.

Thank you for your order. 
Total Purchases  
Shipping Charge*  
Amount Due  

For shop wholesale orders, please call for discount information.

SHOP OWNER TERMS-remit payment with first time orders. Future orders have 30 days until payment is due. Add 1 1/2% per month for bills over 30 days, or $.50 minimum. Payment can be made by MasterCard or VISA.