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NAME:
______________________________________________________________
COMPANY:
____________________________________________________________
ADDRESS:
_____________________________________________________________
SHIP
TO ADDRESS :
____ COMMERCIAL ____
RESIDENTIAL
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 |
|
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SUB
TOTAL |
| |
PRICES
ARE SUBJECT |
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
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CREDIT CARD NUMBER
EXP. DATE
2407B
EMAIL: ORDERS@LTBLENDER.COM