Please refer to the How to Order section before completing this form. The How to Order section explains the entire order process, including payment and shipping.

----------------------------------------------------- PERSONAL INFORMATION -----------------------------------------------------

* indicates required field

*First Name:

*Last Name (Family Name):

*E-mail:

*Address Line 1:

Address Line 2:

*City:

*State: [Choose State] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming [Outside of USA]

*Zip/ Postal Code:

*Country:

Check here if you would like to be on my Mailing List:

--------------------------------------------------------- ITEM INFORMATION ---------------------------------------------------------

*Size: [Select Size] S M L XL XXL

*Fabric Type (Choose 1)	Color:	Liner Color: (Broadcloth)
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Linen	[Select Color] Autumn Gold Black Blue Bonnet Cadmium Chartreuse Chocolate Crimson Emerald English Rose Ginger Green Apple Hyacinth Lavender Mustard Natural Pastel Blue Pebble Pervenche Primrose Red Royal Purple Rust Silver Blue Sunshine Tangerine Ultramarine Vineyard Wheat White Wild Cherry Willow Wisteria	[Select Color] Antique Banda Blue Black Blue Shadow Bronze Burgundy Celery Claret Cobalt Cocoa Copper Cream Dark Denim Denim Grey Hunter Indigo Khaki Lavender Lipstick Light Blue Mauve Mojave Gold Monaco Blue Mulberry Navy Peach Plum Purple Russet Scarlett Sea Green Solid Water Spray Green Sun Tan Taupe Teal Vineyard White Wild Grapes Wine
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Corduroy	[Select Color] Baby Blue Black Brown Grey Khaki Lavender Navy White	[Select Color] Antique Banda Blue Black Blue Shadow Bronze Burgundy Celery Claret Cobalt Cocoa Copper Cream Dark Denim Denim Grey Hunter Indigo Khaki Lavender Lipstick Light Blue Mauve Mojave Gold Monaco Blue Mulberry Navy Peach Plum Purple Russet Scarlett Sea Green Solid Water Spray Green Sun Tan Taupe Teal Vineyard White Wild Grapes Wine
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Silk Noil	[Select Color] Antique Rose Bamboo Black Brick Bright Wine Cashmere Celadon Cherry Claret Copper Coral Deep Olive Dark Brown Dark Taupe Dark Turquoise Dusty Lavender Dusty Olive Eggplant Evergreen Grey Lime Loden Natural Navy Ocean Teal Periwinkle Raisin Red Royal Blue Royal Purple Sand Sky Blue Steel Blue Teal Blue Teal Green Terra Cotta Tiffy Toast Ultraviolet White	[Select Color] Antique Banda Blue Black Blue Shadow Bronze Burgundy Celery Claret Cobalt Cocoa Copper Cream Dark Denim Denim Grey Hunter Indigo Khaki Lavender Lipstick Light Blue Mauve Mojave Gold Monaco Blue Mulberry Navy Peach Plum Purple Russet Scarlett Sea Green Solid Water Spray Green Sun Tan Taupe Teal Vineyard White Wild Grapes Wine
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*Grommet Color:
Silver
Brass

*Trim Color:
Silver
Gold

------------------------------------------------------------------ SHIPPING ------------------------------------------------------------------

Shipping: (Standard shipping By the US Postal Service is free within the continental United States. If you desire another form of shipping, fill out the "other" box below. Shipping to areas outside of the Continental USA, or any other type of shipping other than USPS, is subject to an additional shipping charge. If you live outside of the continental USA, you may leave this section blank. I will inform you of the shipping costs when I send you a confirmation e-mail requesting payment.)

USPS (Free within the Continental USA)
Other (Please Specify)

Comments: (Please include any additonal questions/ comments you may have. I will e-mail you shortly to answer any questions.)