|
Print this form & mail or fax. You may pay by check. You may include
your personal/business cards.
You do not have to send this specific form,
You can type or write your own list and mail or fax.....but please
include all of the
following
info if you write
or type your order.
YOUR Contact Information
Name______________________________________________
Company___________________________________________
YOUR Billing
Address
(where credit card is mailed)_________________________________
City-State-Zip_______________________________________
Phone (h)__________________________ _Phone
(w)______________________
Will you be sending us your own business/personal cards to
enclose yes / no
Payment - check____money order_____
Visa MC Discover Other
Credit card
#_______________________________________________Exp______________
Name on
card_________________________________________Security
Code__________
ITEM to Send______________________Deliver
the week of__________________
Special
Note_________________________________________________________________
.......................................................................................................................................
SHIP TO (Be sure to include the following info
for each
additional gift)
Gift Card
Message______________________________________________
Gift Card
Signature__________________________________________________________
Name______________________________________________
Company___________________________________________
Address____________________________________________
City State
Zip_______________________________________
F or
additional gifts, type or write names, choose gift & email, mail or fax to us.
Toll Free Phone -
888-973-2267 Baton Rouge
area - 627-6852 Fax - 225-383-2832
Mail - Pointe Coupee Pecan, PO Box 10, Glynn, LA
70736......... since 1990
|