Orchardside Yarn Shop
273 Raphine Road
Raphine, VA  24472
 
Order Form
 
Name: _________________________________________ 1
Address: __________________________________________________121
City: _________________________________________121
State: _________________________________________121
Zip Code: _________________________________________121
Telephone: _________________________________________ 
E-Mail _________________________________________
 
Qty
Description
Color
Unit Price
Total Price
11 11 11 11 11
44 44 44 44 44
44 44 44 44 4412
12 12 12 12 12
12 12 12 12 12
12 12 12 12 12
12 12 12 12 12
12 12 12 12 12
1212 121 121 121 121
12 121  12 12 12
12 12 12 12 12
 
                                                             Sub Total
 _________
_________
Sales Tax 5.0%
 _________
 
Total
 _________
 
We accept Visa and Mastercard
____ Check Enclosed
Type Credit Card___________________________
Credit Card Act.#___________________________
Exp. Date_________________________________
 
Thank you for your business!