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Prelock Blueberry Farm
Freshly Roasted Whole Bean
Coffee Order Form
Please fill out the form
below to order your coffee.
Please make out your
check to: Prelock Farm Inc.
Your Name:
____________________________________________
Your
Street Address _____________________________________
Your City, State, Zip _____________________________________
In case we have
questions, your email address is: _____________________________________
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1/2
lb. Bags
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#
Desired
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Price
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Item
Total
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Columbian
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$6
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Sulawesi
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$6
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Costa
Rican
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$6
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Brazilian
Decaf
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$6
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1
lb. Bags
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Columbian
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$12
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Shipping
& Handling Chart
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Sulawesi
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$12
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1-2 lbs.
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$6.95
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Costa
Rican
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$12
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3-8 lbs.
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$12.95
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Brazilian
Decaf
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$12
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8-15 lbs.
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$16.95
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Total
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S
& H
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Total
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Mail this form with your check to:
Prelock Farm Inc.
9632 E. 350 S.
Lafayette, IN 47905-9433
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