* required field

CONTACT INFORMATION
* FIRST NAME:
* LAST NAME:
* BILLING ADDRESS: (Street Address or PO BOX)
* CITY
 * STATE
 * ZIP CODE
SHIPPING ADDRESS (IF DIFFERENT)
 
CITY
 STATE
 ZIP CODE
* EMAIL
 * PHONE NUMBER:(Area Code+Number)
 
PAYMENT INFORMATION
PAYMENT METHOD
 CREDIT CARD NUMBER
EXPIRATION DATE

LAST 3 DIGITS ON BACK OF CARD
(FOUR IF AMEX)

DESIGN INFORMATION
DESIGN NAME:


ATTACH SAMPLE ARTWORK (PLEASE USE: CDR, AI, PDF, GIF, BMP, PNG, JPG, JPEG, PSD)

QUANTITY:


Design HEIGHT In Inches: Design WIDTH In Inches:

IF CIRCULAR, INDICATE DIAMETER

Embroidery Coverage: Check One (embroidered patch only)
100% emb.   Less than 100% emb.

TWILL fabric color: (embroidered patch only)

Number of COLORS in your design over 9: (embroidered patch only)

BORDER(outer edge of emblem) COLOR: (embroidered patch only)

What type of BACKING for your patch?: (embroidered patch only)

ADDITIONAL INFORMATION

TELL US IF YOU HAVE AN EVENT DATE:

Please provide any additional information that will assist us processing you order.

For all other products, pins, t-shirts, hats, etc. please call us to place your order.
1-866-4-A-PATCH (427-2824)
PRODUCTION TIME: ( Normal production is approximately 10 days after order approval )