Prairie Textiles Order Form

You can print this order form and mail or fax it to us, or order by phone.

Prairie Textiles
Box 79341
Los Angeles, CA 90079
Voice 213-614-1757
Fax 213-341-2367

Item#	Quantity	Description	Color	Price
			Subtotal
			Shipping and Handling
			Total

Please charge my Mastercard/Visa/Amex/Discover (circle one).



___________________________________________________
card number                         expiration date


___________________________________________________
name


___________________________________________________
street                                         apt.


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city                                 state      zip

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TELEPHONE 213-614-1757