Bali Fabrics

Customer Purchase Order.
Please print out copy, complete and submit your order by mail or by fax.

Bali Fabrics, 21787 Eighth St. East Suite #1, Sonoma, CA 95476

Telephone: 800 783-4612

Fax: 707 996-9117

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Date of Order:
Requested Delivery:
Customer Number:
Sales Representative:
Customer Name:
Address: State/Zip: Telephone:	____________________________________________
Ship To: State/Zip: Telephone:	_____________________________________________
Buyer Name:
Signature:	_____________________________________________

If applicable, please complete and submit the following

Payment: Visa:____, M/C:____, Amex:____, Check/Money Order:____

Name on Card:
Card Number:
Expiration Date:
Signature:	_____________________________________________________