Please
complete this form and fax it to us at 740.857.1990
Or
call us with your order at 740.857.0000!
Bill to: ______________________________________
Phone # __________________
Address:
_______________________________________________________________
Credit
Card # _____________________Type: ___________
Expiration Date: ________
Time
and Date for Return Call *
_____________________________________________
*
If you do not wish to give a credit card number on this
order form, please give a time and date you would like to be called
back (at
given phone number) to provide this information. Please your include
time zone
(e.g. EST is Eastern Standard Time zone).
|
Circle a Gift Pack:
|
A. Gift Box - $25
|
C. Heart of Ohio Basket - $54
|
|
B. Farmstead Sampler - $40
|
|
Order Wheels of Cheese:
Note: Regular Gouda is $9 per lb.,
Flavored is $10 per lb.
5 Pound Wheels of Regular Gouda
QTY.____
Caraway Gouda
QTY.____
Jalapeno Gouda
QTY.____
Habanero Gouda
QTY ____
10 Pound Wheels of Regular Gouda
QTY.____
Caraway Gouda
QTY.____
Jalapeno Gouda
QTY.____
Habanero Gouda
QTY ____
Send to
:________________________________________________________________
Address:_________________________________________________________________
City, State,
Zip:____________________________________________________________
Message:________________________________________________________________
Deliver
by:_______________________________________________________________
|
Shipping
plus handling will be added to your product order.
We
ship using 2 day ground delivery on Monday through Wednesday only to
insure our
products get to you as soon as possible.
