Faxback Form

PLEASE PRINT CLEARLY

Fax This Form To Mountain Cabin Weaving At: 1-303-479-6333
Make Sure All Information Is Complete And Accurate
"Items ordered by Credit Card, Will Only Be Shipped To The Credit Card Billing Address"
Use this form also if you are paying by check. Checks must clear before items are shipped.

Mountain Cabin Weaving
183 Raven Rock Road
Morgantown, WV 26508

Coasters	___________	___________	Use This Column For Custom Orders Only _______ ______ ________	Total $__________
Place Mats	Style ____________	Quantity ____________	Size Quanty Color _______ ______ ________	$__________
Table Runners	Style ____________	Quantity ____________	Size Quanty Color _______ ______ ________	$__________
Rugs	Style ____________	Quantity ____________	Size Quanty Color _______ ______ ________	$__________
	Style	Quantity	Size Quanty Color
			Sub Total:	$__________
		West Virginia	Residence Add-6%-Sales Tax:	$__________
			Grand Total:	$__________

Payment Options	Visa __	Mastercard __	Discover __
Card Number:	_______________	_______________	_______________
Expiration Date:	_______________	_______________	_______________
	Your	Name Must Be As It Appears On	Your Credit Card.
First Name	_______________	M.I. ___ Last Name:	___________________
Street Address:	_______________	Apt._____
City:	_______________
State:	_______________
Zip Code:	_______________	I'm Paying By Check	__ Check Number________
Home Phone:	( ) - -	Signature:	_______________________
Email Address	______________	____________________

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