Organization Name: _________________________________   Contact Person: ________________________________________

Shipping Address: ________________________________    Contact Phone: _________________________________________

_______________________________________________    Contact Email:  _________________________________________

 Date Needed: ________________

 
 
      Youth Sizes Adult Sizes Cost Per Item Total
Item # Description Color Small Medium Large XLarge Small Medium Large XLarge 2XLarge 3XLarge    
                             
                             
                             
                             
                             
Design Set Up Charges as quoted:    
Shipping:    
Total  Order:    

Special Instructions:  ________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

We require a 50% deposit on all special orders.  Final payment must be made before your order is shipped.  For all embroidery orders totalling
$150 or more you will receive free shipping. If paying by check please make check payable to "Embroidery Gals" and attach it to this
form or fill in the below information for credit card payment and fax this form to 701-327-2168.

Card Holder Name:   Credit Card Number:  
Card Holder Address:   Verification Number:  
 
Embroidery Gals * 4525 Hwy 3*Dawson, ND  58428 - Phone: 701-327-4364  Fax: 701-327-2168