This form is effective from 2/15/2014 2/13/2014 and supersedes all previous forms 5IJTGPSNJTFGGFDUJWFGSPNBOETVQFSTFEFTBMMQSFWJPVTGPSNT Print Form CLEAR FORM Your Name: Street: City: State: Daytime Phone: Zip: TEXT / Cell Phone: When calling this number, should we be dJscreet/confidential? YES NO Email Address: How did you hear about us?: Completed quilt will be: Shipping Address If you are not in the lower 48 states, you will be responsible for additional : $100 deposit included PLEASE BILL THIS CARD UPON COMPLETION OF MY QUILT * PayPal Check Please bill my credit card Account # Name on Card VISA MasterCard Discover Size $Price (# Of T-Shirt Squares) Dorm Twin $375 (24) Wall $250 (9) Lap $275 (12) Stadium $325 (16) Twin $350 (20) California King $475 (42) Full $400 (25) Queen $425 (30) King $450 (36) Runner’s Delight $575 (49) Graduation Package $299 (Lap Quilt & pillow or tote bag) No Thanks Script Block Color: > Message We complete each custom t-shirt quilt in the order it is received. Our average turn around time is -6 weeks. This can vary with our busy seasons, which are Graduation and Christmas Show your love with an American Sign Lanquage “I Love You” hand. This internationally known symbol for love can be placed next to your personalized embroidery. Keepsake Theme Quilts can share my finished quilt photo online: Yes No This form and supersedes all previous forms forms This formisiseffective effective2/15/2014 from 2/13/2014 and supersedes all previous 5IJTGPSNJTFGGFDUJWFGSPNBOETVQFSTFEFTBMMQSFWJPVTGPSNT Front: Cotton only # of T-shirts/Sweatshirts/Jerseys/Shirts/Blouses/Polos Other, please describe Other, please describe Other, please describe > Back: Cotton or Flannel (circle one) > Binding: Cotton only Yes, I would like the unused fronts/backs of my shirts returned to me. No, I do not need the unused fronts/backs returned to me. > * $25 extra for binding in sky blue, brown, country blue, orange, pink and sage Please email me a picture of my t-shirt quilt squares on the design wall for my approval. I want KTQ to arrange my t-shirts. I want to arrange my t-shirts YES Click here for t-shirt guidelines NO 4QFFETVQQSPDFTT You can make your t-shirt quilt unique by customizing it with any of the following special features. Examples of clever ways to incorporate more items include: $ per special feature Combine two or three shirts into one square Combine the front small logo or sleeve with back of shirt Combine up to 4 small logos into one square Includes collars of shirts Includes tank tops, sweatshirts Total x $8 = gives your quilt a splash of color at the intersection of each square Wall - 4 Lap - 6 Stadium - 9 Twin - 12 Dorm Twin - 15 Full - 16 Queen - 20 King - 25 California King - 30 Runners Delight - 30 Subtotal cost of non t-shirt items Number of baby clothes squares Block Color > Number of . Pictures may fade with extended washing. 1 2 4 Total - 8 x 10 = 1 sheet - 5 x 7 = 1 sheet - 3 x 5 = 1 sheet x $10 = Subtotal cost of $10 items . Please check with the manufacturer of the patches for the washing instructions. Number of patches Total x $3 = Subtotal cost of patches The sleeve is used to hang your quilt and can only be added to Wall, Lap Stadium Cost of Quilt selected + Total cost of add ons + = size quilts. Total estimated cost of quilt