JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Custom Pillow Order Request Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Phone Number
*
Your answer
Desired Shape
*
Square
Lumbar
Long Lumbar
Small
Other:
Desired Color
*
Blues
Greens
Silvers & Greys
Golds
Neutrals & Creams
Pinks & Purples
Reds & Corals
COM
Type
*
Embroidery & Applique
Tapestry & Needlepoint
Ethnic
Fortuny
Miscellaneous
Will you require any velvet samples ?
*
Yes
No
Please share any inspiration (with links) here
Your answer
Any additional information to include
Your answer
There is a 50% deposit of the estimate required to begin production on custom designs, do you agree to these terms?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of b viz design.
Report Abuse
Forms
