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Customer Name
Customer Address
Customer Phone Number
Customer Email Address
Gift-Giving Occassion
If Other, Indicate
Specify Gender of Gift-Recipient
Specify Age of Gift Recipient
Specify Crochet Stitch Pattern of Choice
Select Your Style Of Pillow
List Your Primary Color
Color B
Color C
Color D
Color E
How Many Pillows Do You Want
What Size Pillow Do You Want
Do Y ou Want A Border on Your Pillow
List The Border You Want For Your Pillow
What Color Do You Want For Your Border
Do You Want Flowers on Your Pillow
If So, Indicate Flower Choice #1
Indicate Flower Choice #2
Indicate Flower Choice #3
What Color Do You Want For Your Flowers
Do You Want A Butterfly On Your Pillow
If So, Indicate Which One
What Color Do You Want Your Butterfly
Do You Want Buttons on Your Pillow
If So, What Color
How Many
Do You Want To Order
Additional Comments