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Date ______________________________
Order Number_______________________ |
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Ordered By: Name |
Ship To: Name |
| Address | Address |
| City | City |
| State/Zip | State/Zip |
| Telephone: | Best Time To Call: |
| Quantity | Weight |
Whole Bean  - - - Ground - - - Green
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Price | Total |
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Money Order - - Check - - Discover
Master Card - - American Express - - VISA
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Standard Shipping - UPS
Parcel Post
Cont. U.S. Only --------------------- Wisconsin Only |
$ 8.00
------- $ 7.00 |
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| Card Number |
Special Shipping
green coffee, COD, express all offshore destinations, |
Actual Freight |
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| Expiration Date |
5.5% WI Sales Tax
Non Food Items Only |
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| Signature | TOTAL $ |
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Northwestern Coffee Mills 30950 Nevers Rd. Washburn, WI 54891 |
Superb Bean Since 1875 |
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Special Instructions and/or Comments |
| Catalog 2006 www.nwcoffeemills.com |