PLACING AN ORDER USING DIMOCK DAIRY’S
INTERACTIVE PDF
1. When you click the order form button below, you
will be taken to the order form page. Please type your
contact information and then enter the cheese you
want.
2. When finished with your selections, hit submit. The
form will ask you to use your default e-mail to submit.
Please allow it to use this e-mail. Your completed pdf
form will be placed as an attachment to your order
e-mail.
3. Send the e-mail.
Troubleshooting:
I can’t use the submit button, or click and use anything
on this pdf.
Most likely you will need to download the form and
complete it outside of the Internet browser you are
using. If you’ve completed the form and the submit
button continues to be unresponsive, simply save
the completed form like you would any other file on
your computer, and you can e-mail the saved form. If
nothing works, please type out your order in an e-mail
and send it to:
dimockdairy@santel.net
Continue to the Order Form
DIMOCK DAIRY
P.O. Box 26 • 400 Main St., Dimock SD, 57331
Phone (605) 928-3833
Fax # (605) 928-3390
BILL TO:
This is not an invoice. It is an order form to submit to
Dimock Dairy. It does provide you with an approximate
price. A final bill will be sent with your order. Dimock
Dairy does not take debit or credit cards.
Name:
SHIP TO (leave blank if same as BILL TO):
Address:
City:
Name:
State:
Zip:
Address:
E-mail Address:
City:
Phone Number:
E-mail Address:
Today’s Date: 11/12/12
Phone Number:
CHEESE VARIETIES
State:
Price per pound
Zip:
# of lbs
Price
Cheddar - hard, natural cheese
$3.60
$0.00
CoJack - mixture of Colby and Monterey Jack
$3.60
$0.00
Colby - traditional, sweet flavor Blocks sent unless you indicate horns below
$3.60
$0.00
Monterey Jack - buttery taste, easily melted
$3.60
$0.00
Bacon & Onion - Colby with bacon and hint of onion
$4.50
$0.00
Black Pepper - White Cheddar and black pepper
$4.50
$0.00
Caraway - old fashioned Germany style cheese
$4.50
$0.00
Chipotle - Cheddar with roasted chili peppers
$4.50
$0.00
Dill - White Cheddar with plenty of dill
$0.00
Garlic & Parsley - Monterey Jack with plenty of garlic
$4.50
$4.50
Habanero - hot and spicy
$4.50
$0.00
Italian - oregano, basil and rosemary and sage in Monterey Jack
$4.50
$0.00
Pepper CoJack - peppered Colby and Monterey Jack
$4.50
$0.00
Pepper Jack - peppered Monterey Jack
$4.50
$0.00
Pepperoni - White Cheddar, tangy pepperoni & Italian spices
$4.50
$4.50
$0.00
Ranch - Colby Jack with ranch and chive flavor
Salsa - Cheddar with salsa and cilantro
$4.50
$0.00
Smoked Cheddar - White Cheddar and hickory smoke
$4.50
$0.00
Tomato and Basil - Monterey Jack cheese with sweet tomatoes and basil
$4.50
Aged Cheddar - aged a minimum of one year
$5.50
$0.00
$0.00
Bleu Cheddar - Cheddar with a sharp bleu cheese taste
SPREAD VARIETIES & BUTTER
$0.00
$0.00
$5.50
$0.00
Price per container
Quantity
Aged Cheddar - 12 oz. containers
$3.60
$0.00
Cheddar - 12 oz. containers
$3.60
$0.00
Horseradish Cheddar - 12 oz. containers
$3.60
$3.60
$0.00
$3.60
$3.10
$0.00
$0.00
Jalapeño - 12 oz. containers
Smoked Cheddar - 12 oz. containers
Butter - Salted - 1 lb. (4 quarters)
GIFT BOXES, VARIETY PACKS AND TRAYS - gift boxes cannot include Aged
Cheddar, Bleu Cheddar, Drangles or Shullsburg cheeses
$0.00
Price
Quantity
Small Gift Box - 4 one lb pieces (indicate cheese choices below)
$25.00
Large Gift Box - 6 one lb. pieces (indicate cheese choices below)
$35.00
$0.00
$0.00
Spread Gift Box - 4 - 12 oz spreads - crackers (indicate cheese choices below)
$25.00
$0.00
Variety Pack - 9 1/2 lb. pieces
$35.00
$0.00
Variety Pack - 12 1/2 lb. pieces
$40.00
$0.00
Cheese Tray - PICK UP ONLY
$25.00
OTHER PRODUCTS
$0.00
Price
Quantity
1/2 lb. Milled Curds
$2.25
$0.00
Drangles Salami Cheese
$4.50
$0.00
Drangles Horseradish Cheese
$4.50
$0.00
Shullsburg Baby Swiss
$5.50
$0.00
Extra Instructions (let us know if you’re picking up cheese, what cheeses you
want in your gift box, if you want horns for your Colby, and special packaging
instructions)
Amount
Tax 6%
Total (Approx. Price - cheese
weights may vary, and $.20 is
added to each 8oz. or smaller
package )
$0.00
0.06
$0.00
$0.00
Priority Mail Freight will be
added to your final bill
Hitting submit will open this completed form in your email program so that you
can send it to us. Print your own copy or save it on your computer.
Submit Order