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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
    * 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)
  
   CREDIT CARD NUMBER
   		EXPIRATION DATE
 LAST 3 DIGITS ON BACK OF CARD
(FOUR IF AMEX)
 
DESIGN INFORMATION
  

    
 ATTACH SAMPLE ARTWORK / SKETCH / IDEA  

    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?

    TELL US IF YOU HAVE AN EVENT DATE:


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

 

PRODUCTION TIME: ( Normal production is approximately 7 days after order approval )
 
*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: 845-679-5621
Toll Free Phone Number: 1-866-4-A-PATCH (427-2824)