This request is for a: new, repeat or sample Patch it.

Layout: Horizontal or Vertical.

Overall final desired Dimensions: Width Length

Total Dimensions for Design Area: Width Length

Design Area Width: Design Area Length:

QUANTITIES NEEDED FOR QUOTATION

5000 1000 2000 3000 10,000 25,000 50,000 100,000 250,000 500,000 1,000,000

Thread colors: background

Color #1: Color #2: Color #3:

Color #4: Color #5: Color #6:

Backing: Sticker, Permanent Sticker, Heat Seal, No Backing

First Name:  Last Name:

Email: Telephone #

Street Address:, City:, State:

Zip code:

Special Instructions  or Comments / Notes: