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Jackie's Crafts
712-627-4664
1505 Highway 59
Harlan Iowa 51537
E-mail: guzman@fmctc.com


Click Here for Secure Credit Card Order Form


Shipping Charge: Please add $4.95 shipping for the first item and $1.00 for each additional item.

To order please print out this order form and mail it to the address above or click on the link above to use our online form for credit card orders. We accept payment by check, money order, Visa, Mastercard, or Discover.

Customer Information:

Name:___________________________________

Address:_________________________________

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City:___________________State:_________

Zip Code:________Country_______________

Phone number:_________________________

Email Address:_________________________

Ordering Information

Description:________________________________________________Qty:_______Price:______________

Description:________________________________________________Qty:_______Price______________

Description:________________________________________________Qty:_______Price______________

Description:________________________________________________Qty:_______Price______________

Description:________________________________________________Qty:_______Price______________

Description:________________________________________________Qty:_______Price______________

Subtotal:__________

Shipping:__________

Total:__________

Custom Color, Personalization, or Other Special Instructions:

____________________________________________________________

____________________________________________________________

Payment Method

Please circle one: Check / Money Order / Visa / Mastercard / Discover.

Credit Card Information (if paying by credit card):

Name as it appears on credit card:_____________________________

Card Number: ___________________________________

Expiration Date:_____/_____

Your Signature: ___________________________________