Printable Order Form for Mail or Fax

(A)  Shipping Information:		(B)  Mail Or Fax To:
Name: ___________________________
Address: _________________________
Address: _________________________		2106 N. Glenwood Dr.
City:_____________________________		Stillwater, OK 74075
State____________ Zip:_____________
e-mail address:_____________________		Fax: 405-780-7729
Phone:____________________________		International Fax: 001-405-780-7729

Item #:		Item Name/Pattern Brand & Number:		Pattern Size:		Price:
___________		___________________________		__________		$__________
___________		___________________________		__________		$__________
___________		___________________________		__________		$__________
___________		___________________________		__________		$__________
___________		___________________________		__________		$__________
___________		___________________________		__________		$__________

(D)  Shipping & Total Cost: Merchandise Total: $________   Shipping to U.S.: $                   Non-U.S. Shipping: $________   OK residents: 8.5% tax: $________   Total: $________  If paying by credit card:              Are Shipping and Billing Address the same?     ____Yes    ____No                     IF NO, provide your billing address here     for card ownership verification:          * * Thank You! * *

(E)  Payment Method: _____ PayPal                      _____ Money Order _____ Personal Check        _____ Cashier's Check Credit Card (Non-PayPal):         ___Visa  ___MasterCard  ___AmEx                           ___Discover  ___Diners Club Card #___________________________________   Expiration___ ___/___ ___  (Month/Year i.e. 12/04) 3 or 4-digit PIN or V# _________  - may be on card back Name on Card:_____________________________ By signing below, I grant Grandma's House! permission to charge my credit card for the amount indicated, and I agree to pay in accordance with my cardholder agreement. Authorized Signature:________________________________

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