Order Form
|
Description |
Quantity |
Price/unit |
Total Price |
|
Total Price |
|||
Today's Date: ______________________
| Ship to: | Name: |
__________________________________________________ |
| Company: | __________________________________________________ | |
| Street Address: | __________________________________________________ | |
| City, State, Zip: | __________________________________________________ | |
| Contact Phone: | __________________________________________________ | |
| E-mail/Fax: | __________________________________________________ | |
| Need by Date: | __________________________________________________ |
| Billing Information: | Invoice/Check - - Purchase Order # ______________________ |
| Credit Card (please check): | |
| Visa MasterCard American Express Discover | |
| Credit Card Number: _____________________________________ | |
| Expiration Date: ________________________ | |
| Signature: ______________________________________________ |
Sweet Understandings, LLC. |
|
P.O. Box 278, Portales,
NM 88130 |
|
1-866-75-JELLY - |
- Fax: 866-852-2623 |
www.diversitybeans.com - |
- sales@diversitybeans.com |