Prelock Blueberry Farm
Freshly Roasted Whole Bean
Coffee Order Form
Please fill out the form below
to order your coffee.
If you would like to send coffee as gifts or have coffee delivered to
more than one address,
please fill out a separate order form for each address.
Add the totals together
and enclose only one check.
Your Name:
In case we have questions, your email
Your Street Address:
address is:
Your City, State, Zip
|
1/2
lb. Bags |
#
Desired |
Price |
Item
Total |
|||||
|
Brazilian
Decaf |
$6
|
Please check our roasting
schedule |
||||||
|
Columbian |
$6
|
for the next available
roast date. |
||||||
|
Guatemalan |
|
$6
|
|
|||||
|
Salvadorian |
|
$6
|
|
|||||
|
1lb.
Bags |
#
Desired |
Price |
Item
Total |
|||||
|
Brazilian
Decaf |
$12
|
Shipping & Handling Chart |
||||||
|
Columbian |
$12
|
1-2
lbs. |
$6.95
|
|||||
|
Guatemalan |
|
$12
|
|
3-8
lbs. |
$12.95
|
|||
|
Salvadorian |
|
$12
|
|
8-15
lbs. |
$16.95
|
|||
|
Total |
|
|||||||
|
S
& H |
|
|||||||
|
Total |
|
|||||||
Mail this form with your check to:
If sending to a different mailing address:
Prelock Farm, Inc
Name
9632 E. 350 S.
Street Address
Lafayette, IN 47895-9433
City, State Zip
I would like the card to read: