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YES! I WOULD LIKE MY FREE ARTWORK AND A FREE DIGITAL EMBROIDERED SAMPLE! I AM READY TO PLACE MY ORDER
 


ORDER FORM

CONTACT INFORMATION
 
 
    * Have you ordered from us before?
 
   
    * FIRST NAME:
     		* LAST NAME:
    * BILLING ADDRESS: (Street Address or PO BOX)
    
    * CITY
     		* STATE
 * ZIP CODE
    SHIPPING ADDRESS (IF DIFFERENT)
     		 
     CITY
     		STATE
 ZIP CODE
 
    * EMAIL
     		* PHONE NUMBER:(Area Code+Number)
   
   
PAYMENT INFORMATION
    PAYMENT METHOD (REQUIRED)
   		LAST 3 DIGITS ON BACK OF CARD
(FOUR IF AMEX)
SSL Certificate
SSL CERTIFICATES - Get Info
   CREDIT CARD NUMBER
   		EXPIRATION DATE
 
DESIGN INFORMATION

  

    
 ATTACH SAMPLE ARTWORK / SKETCH / IDEA  

If sending a vector file: Please remember to embed fonts or convert to curves/outlines. If you do not know how to do this, please provide the name of the fonts used in your graphic. If sending an Adobe Illustrator file: Please send CS3 or earlier.

 

    QUANTITY:
    

    The General SHAPE of my Design is:
    

    Design HEIGHT In Inches: Design WIDTH In Inches:

    IF CIRCULAR, INDICATE DIAMETER

    Embroidery Coverage: Check One
  100% embroidery   Less than 100% embroidery

    TWILL fabric color:

    Number of COLORS in your design:

    BORDER(outer edge of emblem) COLOR :

    What type of BACKING for your patch?

    Date you need your patches in-hand :


    Please provide any additional information that will assist us processing your order.
    

 

We use the most state-of-the-art encryption methods to ensure your information is as safe and secure. This is achieved by means of Secure Sockets Layer (SSL) software, which encrypts your credit card number, name, and address. When excrypted, it cannot be views by any third party as it travels over the Internet.
 
*DISCLAIMER: 'CUSTOM PATCHES' assumes that its customers have the right to use all of their designs, including trademarked and/or copyrighted logos sent to us for reproduction. We will assume no liability in any trademark or copyright infringement disputes.
 
E-mail: sales@custompatches.net. . . . . . . . . . . . Fax: 866-304-7655
Toll Free Phone Number: 1-866-4-A-PATCH (427-2824)
PO Box 777, Bearsville, NY 12409