Mail-Order Form
Customer Information:
First Name:
Last Name:
Shipping Address:
Telephone:
E-Mail:
Order Information:
Order Date:
Unit Price
Total Amount
(350pc) Vanilla Fortune Cookies
_______ x $ 12.85
= $ _________
CSWCIB
(350pc) Citrus Fortune Cookies
_______ x $ 12.85
= $ _________
CSWCHB
(350pc) Chocolate Fortune Cookies
_______ x $ 14.20
= $ _________
CSWTF
(350pc) Tri-Flavor Fortune Cookies
_______ x $ 14.20
= $ _________
Item Code
Description
CSWCOB
Qty
Qty
Shipping & Handling Charge
UPS Ground
Unit Price
_______ x $ 27.00
Total:
= $ _________
= $ _________
Payment Method:
Credit Card Only; No Check Accepted
Credit Card Information:
Billing Address:
Credit Card #:
*** Name on card if different:
Expiration:
☺ Please fax order form to (718) 628-7788