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     Place your order below:

Required fields are marked with *


                                   Your Name:*                               
   
                                   Address:*                                     
 
                                   Address2:                                     

                                   City:*                                            
 
                                   State:*                                          
							
                                   Zipcode:*                                        ex: (12345-6789)

                                   Phone:*                                          ex: (123-456-7890)

                                   Email:*                                        
 
                                   Confirm Email:*                         
 
                                   How did you find us:                   
 
                                   Please choose your pattern:*      
 
                                   Describe your quilt:*                   

                                  Quilt width (in inches)*     Quilt length (in inches)*  

                              *If you would like and email estimate before sending  your quilt, please indicate so below.                                     
                        Do you have any questions  or special requests?:     

     Do you have a shipping     UPS           Other                   Contact us to discuss if you would
      provider preference?        US Postal  No preference       prefer us to use another courier.

                              Would you like shipping insurance?  If so, how much?   $ 

     Batting Selection:*               I will provide my own
                                                    Hobbs 96" 80/20 Cotton / Poly
                                                    Hobbs 108" 80/20 Cotton / Poly
                                                    Warm and Natural / White 96"
                                                    Warm and Natural / White 108"

                                                 Submit your order  or 
          

Upon completing your order, please mail your quilt to:

Gayle's Quilting Patch

P.O. Box 175

Boones Mill , Va.

24065-0175