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|SUPPLIES ORDER FORM | |Japanese Embroidery Center |

|Pg. 1 | |2727 Spalding Dr., Atlanta, GA 30350-4623 |

|Or shop securely online at | |Tel (770) 390-0617 Fax (770) 512-7837 |

| | |Email: info@ Web: |

|( Date order placed mm/dd/yyyy | |Name LAST , FIRST _ |

|Supplies will ship within 7 business days unless ordered with | |Address STREET__________ |

|fabric. | | |

| | | CITY________ST/PROV_POST/ZIP_COUNTRY |

| | | |

|( Expedited delivery needed by mm/dd/yyyy | |Phone       Fax       Email       |

|Additional charge of $10. | |Payment method: |

| | |CC# ×××× - ×××× - ×××× - ×××× Exp. mm/yy CVV ___ |

| | |Order will not be processed w/out complete payment info. Balance will be charged upon completion of |

| | |processing. |

| | | |Shipping – Domestic: UPS Ground; Int’l: USPS Express Mail International |

|For Teacher Use Only | | |Shipping address (if different than billing address above): |

|( Purchase Order #: -0 - - . | | | STREET__________ |

| | | | CITY________ST/PROV_POST/ZIP_COUNTRY |

| | | |( We can ship to PO boxes only if street address also provided.) |

|Membership | | |Qty|Retail price |

|Entitles you to Mem. price, journal subscription & | | | | |

|other offers. Any membership amt. above Friend is tax| | | | |

|deductible. | | | | |

|Type: | |needl| - |33.50 |30.| |

| | |e set| | |15 | |

| | |

|SUPPLIES ORDER |Japanese Embroidery Center |

| |Email: info@ Web: |

|Pg. 2 | |

| |Qty |Retail price |Mem| |

| | | |. | |

| | | |pri| |

| | | |ce | |

|#0.8 |

Red | |Flame | |Leaf Green | |Peacock | |Celadon | |Blue Purple | |Cranberry | |Fig | |OFS Peach | | - |101 | | - |234 | | - |411 | | - |488 | | - |541 | | - |611 | | - |671 | | - |743 | | - |217 | | - |102 | | - |235 | | - |412 | |Sage | | - |542 | | - |613 | | - |672 | | - |748 | |OFS Green | | - |103 | | - |236 | | - |413 | | - |492 | | - |544 | | - |614 | | - |674 | | - |749 | | - |405 | | - |105 | | - |237 | | - |414 | | - |493 | | - |546 | | - |616 | | - |676 | |Aubergine | |OFS Blue | | - |106 | |Yellow | | - |415 | | - |495 | | - |547 | | - |618 | | - |678 | | - |754 | | - |506 | | - |107 | | - |301 | | - |417 | | - |497 | | - |548 | | - |619 | |Plum | | - |757 | |OFS Antique Purple | | - |108 | | - |302 | | - |418 | |Blue | | - |549 | |Antique Purple | | - |681 | |Dull Brown | | - |626 | | - |109 | | - |304 | |Brown Green | | - |501 | |Aqua | | - |621 | | - |682 | | - |767 | |OFS Mauve | |Red Orange | | - |305 | | - |423 | | - |502 | | - |553 | | - |623 | | - |683 | |Grey Brown | | - |657 | | - |113 | | - |308 | | - |425 | | - |503 | | - |555 | | - |624 | | - |684 | | - |777 | |OFS Achromatic | | - |114 | |Butter Yellow | | - |426 | | - |504 | | - |557 | | - |625 | | - |685 | |Achromatic | | - |801 | | - |115 | | - |311 | | - |427 | | - |506 | | - |558 | | - |626 | | - |686 | | - |801 | |OFS Black | | - |117 | | - |312 | | - |428 | | - |507 | |Turquoise | | - |627 | | - |687 | | - |803 | | - |809 | | - |119 | | - |314 | | - |429 | | - |508 | | - |563 | | - |628 | | - |688 | | - |804 | |OFS Golden Cream | |Pink | | - |316 | |Bronze | | - |509 | | - |566 | |Red Purple | | - |689 | | - |807 | | - |905 | | - |122 | | - |318 | | - |432 | |Blue Haze | | - |567 | | - |632 | |Wood Rose | | - |808 | | | | | - |125 | |Wheat | | - |433 | | - |512 | | - |568 | | - |633 | | - |693 | | - |809 | | | | |Orange | | - |321 | | - |434 | | - |514 | | - |569 | | - |636 | | - |696 | |Steel Gray | |TOTAL

original flat silk | | - |201 | | - |323 | | - |435 | | - |517 | |Prussian Blue | | - |637 | | - |697 | | - |811 | | - | | - |202 | | - |325 | | - |436 | | - |518 | | - |572 | | - |638 | |Brown | | - |812 | | | | | - |203 | | - |326 | | - |438 | |Bright Blue | | - |576 | |Burgundy | | - |701 | |Taupe | | | | | - |204 | |Goldenrod | |Seafoam | | - |521 | | - |578 | | - |641 | | - |702 | | - |825 | | | | | - |206 | | - |332 | | - |441 | | - |522 | |Ultramarine | | - |642 | | - |704 | | - |827 | | | | | - |207 | | - |334 | | - |442 | | - |523 | | - |582 | | - |644 | | - |705 | |Golden Cream | | | | | - |208 | | - |336 | | - |444 | | - |524 | | - |583 | | - |646 | | - |706 | | - |901 | | | | | - |209 | |Butterscotch | | - |445 | | - |525 | | - |584 | | - |648 | | - |708 | | - |902 | | | | |Peach | | - |341 | | - |446 | | - |527 | | - |585 | | - |649 | |Rose Brown | | - |903 | | | | | - |211 | | - |343 | | - |447 | | - |528 | | - |586 | |Mauve | | - |714 | | - |905 | | | | | - |213 | | - |345 | |Emerald | | - |529 | | - |587 | | - |653 | | - |715 | |Vein | | | | | - |215 | |Taffy | | - |453 | |Blue Green | |Williamsburg Blue | | - |654 | | - |716 | | - |911 | | | | | - |216 | | - |352 | | - |456 | | - |532 | | - |593 | | - |655 | | - |717 | | - |912 | | | | | - |217 | | - |355 | |Malachite | | - |535 | | - |595 | | - |656 | | - |718 | | - |913 | | | | |Apricot | |Burnt Orange | | - |465 | | - |537 | | - |596 | | - |657 | |Orange Brown | | - |916 | | | | | - |222 | | - |366 | | - |467 | | - |538 | |Violet | | - |658 | | - |722 | |Pollen | | | | | - |223 | |Green | |Yellow Green | | | | | - |601 | | - |659 | | - |723 | | - |924 | | | | | - |225 | | - |402 | | - |472 | | | | | - |603 | |Blackberry | | - |724 | | | | | | | | - |226 | | - |404 | | - |473 | | | | | - |605 | | - |662 | | - |726 | | | | | | | | - |228 | | - |405 | | - |474 | | | | | - |608 | | - |663 | | - |727 | |TOTAL

flat silk | | | | | | | | - |406 | | - |475 | | | | | - |609 | | - |666 | | - |728 | | - | | | | | | | | - |408 | | - |476 | | | | | | | | - |669 | |Fawn Brown | | | | | | | | | | | - |409 | | - |477 | | | | | | | | | | | - |733 | | | | | | | | | | | | | | - |478 | | | | | | | | | | | - |734 | | | | | | | | | | | | | | | | | | | | | | | | | | - |735 | | | | | | | |(Revised 08/2016) | | | | | | | | | | | | | | - |736 | | | | | | | |

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