Order Form
(Please Print)		 Pine Island Primitives
16369 County 11 Blvd.
Pine Island, MN 55963
507-356-2908
 rugs@bevcomm.net
Mailing Address:
Name:
Address:                                                                                        
City:                                                                State:                        Zip:
Phone:                                                             Email:

Payment Method: (Check One) US DOLLARS ONLY

___ Check                 ___ Money Order                   ___ Credit Card
Card Number:  _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Exp. Date: _ _ / _ _
Name on Card:   Last 3 Digits on back - _ _ _

If paying by check or MO please make to: Pine Island Primitives

 Quantity  Description  Price  Total
       
       
       
       
       
       
       
       
       
       
       

US Shipping & Handling:
Under $12 - $6
$12 to $50 - $10
$51 to $100 - $12
$101 to $200 - $18
$201 to $300 - $25
Over $300 please call.
Please call or email for International shipping rates.

Subtotal

  

Tax 6.875% (MN only)

 
Shipping  
Balance Due  

Thank you for your order. We appreciate your business.
All prices listed are in US dollars. Please be certain of your purchase. Each of our canvases include a color photo of the finished rug for reference only. The prices shown are for the canvas with the image hand-drawn for you to finish. Not the finished rug. Please be careful of your selections.  All sales final.