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.

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