Print out this form and mail to:  

Cost:

• $15.00 (US) for custom black and white pattern, floss guide and instructions.
• $3.00 (US) for each additional copy of your pattern.

Please send full payment with your order.  Make check or money order payable to :  Peggy Cook

Name:

Address:

City:                                                        State:                                             Zip:

Phone Number: (in case I have a question about your order)

Email: 

If needed what is your preferred method of contact?  Phone   or   Email

Custom Pattern Specifications:

Approximate Size of Finished Cross Stitch (in inches):

Aida Count:

Number of Floss Colors:  (I recommend 30, no less than 20):

Photo Specifications:

Please indicate any special notes regarding your photo. 

Removing and objects or background?

Does the photo need to be cropped? (If necessary, photocopy photo and crop to your specifications)

Would you like your finished project to be in color or black and white?

Include any additional notes here:

Payment:

Please enclose full payment with order.  Make check or money order payable to PeggyCook