Personalised Register Sampler
Order Form
Date
*
Your name and address for delivery:-
Name
*
Address1
*
Address2
Town
*
Post (zip) code
*
Country
*
E-mail Address:
*
Telephone number
Embroidery details:-
Embroidery type
*
Cross stitch only
Cross stitch with special stitches
Cross stitch with special stitches and cut work
Capitals style for Family name
*
Style 1
Style 2
Style 3
Style 4
Letter style for all other wording
*
Style 1
Style 2
Style 3
Anniversary number
(e.g. 25, 50 etc - optional)
Large central letter (monogram)
*
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Details of the parents:-
Family name
*
Full name of father
*
Full maiden name of mother
*
Date of marriage (optional)
Details of the children:-
Birth Death BD1 Name1 Event1 Age1 BD2 Birth Death Name2 Event2 Age2 BD3 Birth Death Name3 Event3 Age3 BD4 Birth Death Name4 Event4 Age4
Birth / Death
Name
Date of event
Age at death*
( deaths only)
/
/
/
/
* add w, m,, or d for weeks months or days; e.g. 5m for 5 months.
Stitcher details:-
Stitcher's name (as you would like it to appear)
Year the sampler was worked
Relationship to family (optional)
Special requirements:-
*
Required