geier's designs photo & file to pattern / Order Form Date:___________________ Name:__________________________________________________________________ Address:_______________________________________________________________ City:____________________________ State:___________Zip:________________ Email:___________________________ Phone:_______________________________ Finished width of cross-stitch:______ Count (10 count-40 count):____ Cloth color (for background) Name:______________ DMC # (if known):_____ Floss type (DMC or Anchor):________ Maximum # of colors (2-150):_____ If your photo requires area cropping or background removal: Create a rough drawing on the back of this form showing measurements to the corners of area to be cropped. If you want the background removed then outline or describe the area (such as remove sky area behind lighthouse). If background is removed you will need to give a substitute cloth color such as "light blue" DMC # 775. Lighthouse chart numbers:_________________ Each Chart $5.00 = $___.__ Charts from Files Each $12.95 = $___.__ Charts from Photos or artwork Each $19.95 = $___.__ We can not accept credit card orders. Total Enclosed: $___.__ Please enclose check or money order payable to Geier's Designs. Send form, photo or disk and payment to: Geier's Designs P.O. Box 2158 Portland, OR 97208-2158 Note: We can not be responsible for loss or damage to your photo or disk incurred during shipping. Use the FILE and PRINT options of your browser to print this page.