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HAWAIIAN FLORAL MIST CUSTOMER ORDER FORM RETURN FAX FOR ORDER (808) 968 - 6687 CUSTOMER NAME ________________________________________________________ BUYER NAME ________________________________________________________ PHONE ( ____ ) _____________ FAX ( ____ ) _____________ CUSTOMER ADDRESS ________________________________________________________ ________________________________________________________ ________________________________________________________ # OF CASES Gallons _________ # OF CASES QUARTS _________ PRICE GALLONS $_________ PRICE QUARTS $_________ TOTAL THIS BILLING (inc. Shipping) $_________ TERMS (CIRCLE ONE) BILL CASH 30DAY(from shipping date) COD SPECIAL INSTRUCTIONS *SHIPPER TO SPLIT SHIPPING ON INITIAL ORDER ONLY ORDER CONFORMATION___________________________________________ |
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Alohilani Farms
P.O. Box 1317
Kurtistown, HI 96760