Customer Name: Address: City: Other: Quilt Description: Jukebox Quilts Quilt Intake Form Phone: Cell: Email: State: Zip: Drop off date: Due by date: Rush Fee $30 min. Measurement of top: Measurement of backing: Placement directions (centering of quilt on backing $25 extra): Pattern/quilting request (if you're not sure, we'll help you pick): Who can we thank for referring you? Please see back of page for estimates. Actual charges may vary and will be shown on your invoice, which is provided to you when you pick up your quilt. Estimates do not include sales tax. Your quilt will be ready in 1-3 weeks (exception: Space Program quilts will be ready within 60 days) unless it requires custom design/quilting which can take longer. We make all attempts to accommodate your needs just let us know in advance. Disclaimer---Fullness/puckers cannot always be quilted out; we do not guarantee they will not be sewn in; in some cases excessive fullness may cause the quilt to not be square. Mechanical Disclaimer---Sewing machines are mechanical devices. Despite careful maintenance, mechanical problems may occur and cause damage to a quilt top or back. By signing below you are indicating that you have read and understand these disclaimers. As well, you have reviewed and authorize the above work to be completed on your quilt by Jukebox Quilts. You also understand that quilting is an art and not exact. Minor imperfections are normal. You understand that you are financially responsible for the cost of services as stated. If the quilt is displayed in a show or publication, you agree to credit the machine quilting to Jukebox Quilts. We will make and document several attempts to reach you, but quilts left for longer than 3 months will be considered abondoned and the property of Jukebox Quilts. Payment in full is due when you pick up your quilt. We accept cash, check, or Mastercard, Discover, and Visa. Please sign below to indicate that you agree to the estimated charges and the patterns/thread that we have chosen together for your quilt. If additional charges will be incurred, we will attempt to contact you to inform you of these charges. May we have your permission to photograph your quilt and possibly use it on our website, in social media or in a presentation about quilting? Indicate if you'd like us to identify it by your full name or only initials. Yes Signature Identify by my full name Identify by my initials only No photography permitted Date Charges: Estimates only, final pricing depends on hours required for project: Square inches top: __________"X__________" X__________ per sq. inch Edge to Edge: Loose: .025/square inch Moderate: .03-.0375/square inch Dense: .0375-.045/square inch Custom border with border to border fill: Loose: .035/square inch Moderate: .035-.0375/square inch Dense: .0375-.04/square inch Semi Custom (each block quilted with specific pattern): .035-.045/square inch Custom: .055 and up/square inch Heirloom: .075 and up/square inch Minumum quilting charge: $50 Estimated Quilting Charge Actual Quilting Charge Thread* (Color changes $5 each, different color front and back additional $25): Thread Charge * Thread request: Thread price: Loading - add $25 per hour for minky, flannel, denim, or polar fleece backing Pinning Charge Batting* Customer provided batting - type: Jukebox provided: 80/20 Cotton Poly 80/20 Cotton Wool 100% Cotton 100% Wool Poly Square inches batting*: __________"X__________" X__________ per sq. inch Batting by the yard: yards/ width Batting Charge Other: Other * Pattern Charge- Name of Pattern: Backing Backing fabric yardage provided by Jukebox*: Pattern Charge * Backing fabric piecing or preparation: Binding: Backing Charge * Binding applied to quilt front by machine ($2 per linear foot for customer prepared, $3 if we prepare): Binding Charge Curved or scallop: Hand finished on back: Sleeve Charge Machine finished on front and back (add $1 per linear foot to charge above): Sleeve placement: Other Charges (Rush Fee $30.00) Other Repair, pressing, border adjustments, etc. will be billed at $25 per hour: Checklist In Trello Date/Initials On Calendar Invoice on Hold Stitch Counts: Customer Called Thank You Sent Subtotal Tax (* items taxed only) Deposit Final Total