By Hull By Hand R. 1 Box 93 St. Francisville, IL 62460

Name	_____________________________
Street	_____________________________
City	_____________________________
State & ZIP	_____________________________
Phone	_____________________________

Name of Item or Pattern	Quantity	Amount

Total from above	_____________
6.25% IL Tax (IL residents only)	_____________
Total Amount Enclosed	_____________

If paying by Credit Card:
Credit Card Number	________________________________
Expiration Date	________________________________
Your Signature	________________________________