Name:___________________________________________  Phone:__________________

Address:_________________________________________________________________

City:______________________________________________ State:_____ Zip:_________

Events Date                  Events  Description                                                  Cost

                                                                                                                         $                        

                                                                                                                         $                        

                                                                                                                         $                        

                                                                                                                         $                        

                                                                            TOTAL. . . . . . . . . . . . $______________    

__________ Check Enclosed (made out to Merri Stitches, Inc.)

__________ Please charge my credit card (fill in below)

Credit Card: _________________________________________________________

Credit Card #:________________________________________________________ 

Exp. Date:        _________

Cardholder Signature: _________________________________________________

Date:  ____________________