The Smocking Room
8090 Columbia Road
Olmstead Falls, OH 44138
Date:
MAIL IN ORDER FORM
Name_________________________________________________________________
Address_______________________________________________________________
City, State, Zip_________________________________________________________
Email ________________________________________________________________
Phone #_______________________________________________________________
Garment being ordered:__________________________________________________
Size:_____________
Price: _______________
Changes to garment:
Fabric________________________________________________________________
Color of fabric__________________________________________________________
Color of smocking_______________________________________________________
Color of embroidery_____________________________________________________
Type of lace___________________________________________________________
Neckline style: no collar___ peter pan collar___ square collar___ V collar___
round collar___ short lace ruffle (standing up)___ long lace ruffle ___
Sleeve style: (select as many as apply) short___ long___ puffed ___ straight___
cuff and piping___ smocking___ elastic___ fabric ruffle ___ lace ruffle___
lace beading and ribbon___ fabric ruffle with lace___
Bodice style: yoke and smocking___ full bodice smocking___ plain bodice___
shadow work embroidery___ silk ribbon embroidery___
Hem style: plain hem___ scallop hem with lace ruffle___ Madeira hem____
embroidery at hemline___ straight hem with inside scallop____
Additional touches: (lace shaping, shadow work, crewel embroidery, silk ribbon embroidery, pintucking,
etc.):_____________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________
Price of original garment: $_____________
Payment: cashier's check___ Credit Card____________________ Expiration Date _________
Cost of additional work due to changes will be discussed through email or by telephone.