|
Please print and return to Susan Wenzel , 4569 Rincon Place, Dumfries, VA 22025-1045
LACY SUSAN BOBBIN A MONTH CLUB
Name: ______________________________________________________
Address:______________________________________________________
______________________________________________________
Phone: ______________________________ Email: __________________________
Optional Credit/Debit card information:
Name as it appears on the card____________________________________________
Card billing address (if different)____________________________________________
Type of card:___________________________ Credit Debit (circle one)
Number __________________________________________________________
Expiration date________________ 3 digit identity code on back_____________
Club name: _________________________________________________________________________
Style bobbin:________________________________________________________________________
Wood/bone choice Midlands and Honiton (circle one) Lemonwood Ebony Bone
Spangled: (Midlands Only - circle one) Yes No
Number of bobbins ordered per month:___________________________
I acknowledge that club cancellation policy requires 60 days notice _____________________ (initials please) ____________
|
