1. Provide Contact Information:
Full Name: Position: *
Organization Name: * Telephone:
Address: Fax:
City, State, Zip: E-mail:
* Fill out only if ordering for an organization, and please ensure provided address is that of the organization

  2. Select Quilt type (choose only one):
Personal Huppah Quilt (wedding canopy)
      Names of Couple:      		 Memorial Quilt 
Anniversary Quilt
Congregational Huppah Quilt Bar/Bat Mitzvah Quilt
"Mi Sheberach" Quilt Dedication Quilt
Ark Curtains Quilt Tallit Quilt
      Name of Child:
Baby Blanket Quilt
 B'rit Milah (circumcision) Pillow Quilt
Mizrach Quilt Other Theme Quilt (specify):

  3. Choose Fabric Color and Quilt Size:
 Fabric color: white   ivory   squares wide X   squares high
 If you would like some spare Square kits at $4.50 each, please indicate quantity:

  4. Select Design Templates From Categories Below:
   The number of design templates should correspond to the number of square kits you order.
   Floral

001
002
003
004
005
006
007
008
009
010

011
012
013
014
015
016
017
018
019
020

021
022
023
024
025
026
027
028
029
135

209
232
302
311
320
321
   Guardians: Angels, Hamsah, Priestly Blessing, and Facing Lions

030
031
032
033
034
035
036
037
038
039

040
041
042
043
044
081
083
084
085
086

087
094
095
096
097
098
099
153
154
155

156
163
165
166
306
   Stars of David, Menorahs, and Crowns

046
047
048
049
050
051
052
053
054
055

056
057
058
059
060
061
062
063
064
065

066
067
068
088
089
090
091
092
093
107

108
245
   Torah, Ten Commandments, and Learning

069
070
071
072
073
074
075
076
077
078

079
080
082
109
124
125
134
243
244
246
   Jerusalem

100
101
102
103
104
105
106
360
361
362

363
364
365
366
367
368
   Celebrations: Love, Marriage, Birth, Mazal Tov, and Lechayim

110
111
112
113
114
115
116
117
118
119

120
121
122
123
128
129
130
131
132
133

225
226
300
301
308
309
   Creatures of Earth and Sky

136
137
138
139
140
141
142
143
144
145

146
147
148
149
150
151
152
157
158
159

160
161
162
164
167
247
   Seven Varieties of Israel

168
169
170
171
172
173
174
175
176
177

178
179
180
181
182
183
184
185
222
304

305
323
324
325
326
327
   Holidays

186
187
188
189
190
191
192
193
194
195

196
197
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201