Selma's Yarns and Needleworks Order Form "Your #1 Source For Needlework!" Ordered By: Name: __________________________________________________  E-Mail: __________________________ Address: _______________________________________________________________________________ City: _________________________ State: _______________ Zip Code: ____________________ Phone #: _____________________________ Qty. Item Description Item # Price                                                                                                   Sub-Total   Sales Tax   Shipping   Total   Connecticut Residents Please Add 6% Sales Tax Please See Below For The Shipping Terms   Shipping: Up to $15.00 : $2.35       $15.01-$50.00 : $5.15       $50.01-$75.00 : $6.20       Over $75.00 : FREE       Please Note:   For international orders please call to get shipping rates. Payment Method   Please circle one payment method:     Check     Money Order     Visa     Mastercard Card # ____________________________________________ Exp:______/_______ Signature _________________________________________ Date:______/______/______ By Mail: By Fax: Please enclose payment and send to: Selma's Yarns and Needleworks 24 Hickory Lane Roxbury, CT 06783 Please fax this form along with your credit card information to (860) 350-2284. Please Allow 1-2 Weeks For Delivery