21 West Riverside Drive, Jupiter Florida 33469

Needlepoint Belts - Order Form

Date _____________________________________Telephone number_____________________________

Store Name _________________________________________________________________________

Store Address _______________________________________________________________________

City ________________________________State_______________________ Zip ________________

Salesperson name ___________________________________________________________________

Canvas Design such as Golf Clubs, Flowers, etc. _____________________________________________

NOTE: Please mark “Top” on the canvas to indicate the top of the design.

Buckle - Please circle your choice:

Buckle should be on the left side _____ or right side ______ when putting belt on before buckling.

The buckle on the left side is the regular position.

Belt Color - Please circle your choice:

Belt Size: _____________________Approximate width of finished belt __________________

Special Instructions:

__________________________________________________________________________

The finished canvas for the belt should be approximately 4" shorter than the waist size (include pants when measuring) or measure from a person’s existing belt as shown in the brochure. For example, waist 30" - finished canvas should be 26" or longer. One row or more depending on the approximate width of the finished belt will be turned under to secure finishing along each long edge. 1 ¼ “ will be overlapped by leather at each end.

Wholesale Price list – please call

Please call Mike at 561-310-1468 for questions. We appreciate the opportunity to finish your needlepoint.

Turn around time averages 10 days

* Not responsible for fiber discoloration during blocking. Please use colorfast thread and paint on your canvas.

** Please see our brochure or web page for instructions on measuring belt size correctly. If you have any questions, just call.

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