RETAIL ORDER FORM

409-765-5666

WWW.MARGARITAINABAG.NET

 

 

 

NAME:     ______________________________________________________________

 

COMPANY: ____________________________________________________________

 

CANNOT SHIP TO PO BOX-

PLEASE PROVIDE A PHYSICAL ADDRESS IN THE CONTINENTAL US

 

ADDRESS: _____________________________________________________________

 

SHIP TO ADDRESS :             ____ COMMERCIAL   ____ RESIDENTIAL

 

CITY ________________________________ STATE: ______    ZIP: _______________

 

DAYTIME PHONE: _______________________________________________________

 

FAX: __________________________________________________________________

 

EMAIL: ________________________________________________________________

 

 

 

 

 

DESCRIPTION

QUANTITY

PER CASE

TOTAL

MARGARITA IN A BAG-

1 CASE (12 BAGS)

 

X $85.00

 

MARGARITA IN A BAG-

3 BAG PACK

 

X $25.00

 

 

SUB TOTAL

 

PRICES ARE SUBJECT
TO CHANGE

SALES TAX

 

PRICE INCLUDES SHIPPING

ADD 8.25% IF DELIVERED IN TX

 

Code: EH

 

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

METHOD OF PAYMENT: (CHECK ONE)

____ CHECK OR MONEY ORDER PAYABLE TO: FRESH MARKET

____ VISA            ___ MASTERCARD        ___ AMEX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                         

   CREDIT CARD NUMBER                                                        EXP. DATE                          

 

 

Fax to :    713-528-3651

Mail to :   LT. BLENDER’S ORDERS
               C/O FRESH MARKET

               2407B Rice Blvd.
              
Houston, TX
.
77005

EMAIL:   ORDERS@LTBLENDER.COM