Application for Quilt Appraisal Quilt Appraisal Application Form Section Note: This Appraisal is for personal use only and gives a replacement value only. If you wish to insure your quilt, you must contact your insurer to discuss the matter with them. Queensland Quilters Inc gives no assurance that your insurance provider will use this appraisal when determining an insurance value. Quilt Owner (if not the Quilt Maker) Membership Number Quilt Maker * Membership Number * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Email Phone Landline Phone Mobile Quilt Title * Quilted by * Year Made * Size (to nearest cm) Width (to nearest cm) * Length (to nearest cm) * Intended Use * Bed Wall Hanging Art Quilt Other Predominant Colours * Has this quilt won any Awards? * Yes No Please give details of any Awards won Design Source – Please give as much detail as possible Original Traditional Kit (include Cost) Block of the Month (include Cost) Other – book, magazine, pattern Construction Details * Hand pieced Machine pieced Hand applique Machine applique Hand embroidered Machine embroidered Beaded Surface and other techniques Please tick all that are appropriate Materials Used * Please give as much detail as possible e.g. cotton, silk, antique fabric, hand dyed fabric by the quiltmaker, use of Vliesofix, foundation papers or stablisers, type of beads, type of embroidery threads, etc Handquilting Hand quilted by Tied by Machine quilted by Quilt Maker Type of Machine used Domestic Mid Arm (sit down) Long Arm Computerised Quilting Stitch Regulated Quilting Non Stitch Regulated Quilting Machine Quilting by Commercial Quilter Name of Commercial Quilter Cost charged for machine quilting Business Name of Commercial Quilter Type of Machine used Domestic Mid Arm (sit down) Long Arm Computerised Quilting Stitch Regulated Quilting Non Stitch Regulated Quilting Batting Was the batting included in the machine quilting fee Yes No Type of batting used e.g. wool, poly, cotton, silk, bamboo, pelon etc. Binding Did the Quilt Maker apply the binding? Yes No If binding was not done by the Quilt Maker please give details and cost $ Cost to construct the Quilt Please supply as much information as possible Cost of kit/block of the month $ Quilting $ Fabric Top $ Binding $ Batting $ Backing Fabric $ Other Information Please supply information that is important for this valuation e.g. Group Quilt, Raffle Quilt Text Copyright Is your quilt taken from a design or image where copyright could be an issue? * Yes No Has permission been sought to use the design or image? * Yes No Photographs of your Quilt Please upload 1 photograph of your complete quilt. The photo should be labeled surname_quiltname, e.g. Jones_My Fairy Garden File Upload * Drop a file here or click to upload Choose File Maximum upload size: 2MB Payment of Appraisal Fees $20.00 members, $30.00 non-members. You can make payment by Direct Deposit to Queensland Quilters OR by Credit Card Direct Deposit Name of Account: Queensland Quilters Inc BSB: 034-002 Account Number: 768617 Please include your last name and Appraisals as the payment reference. Credit Card Please contact Verna Hunt with your credit card details. Mobile: 0409 062 485 Disclaimer While every care will be taken, neither Qld Quilters Inc., nor the co-ordinator/Appraisers can be held responsible for loss or damage to the quilt in the process of being appraised. The owner is responsible for insurance of the quilt. The quilt must be delivered and collected by the owner or representative – the quilt owner will bear all cost associated with delivery and return of the quilt. If you wish to have your quilt posted back to you, please include the cost of registered return post at delivery of your quilt. Signature Clear Date Submit If you are human, leave this field blank.