Complete this form to reserve
a quilt and pay by check
If you would like to purchase a quilt and pay with a
check, use this form to reserve the quilt.  When we
receive your check for price of the quilt, plus $25
handling & shipping charges), we will send you the  
quilt you have purchased.  Mail your check to:  
       Quilts for O
rphans
       83 Boy Scout Road
       Kutztown, PA 19530
Name of quilt
Your email address:
Your phone
number:
Your name and
complete street
address
Comments: