Print and fax/mail order form - NORTHWESTERN COFFEE MILLS

NORTHWESTERN COFFEE MILLS
30950 Nevers Road, Washburn, Wisconsin 54891
phone: 800-243-5283 local: 715-373-2212 fax: 715-373-0072

Date:_______________

Ordered By: Name:	Ship To: Name:
Address:	Address:
City:	City:
State: Zip:	State: Zip:
Telephone:	Best time to call:

Quantity:	Weight	Product Whole / Ground	Price	Total

Credit Card Information:

__ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
    Account Number

    ___ ___ - ___ ___        ________
    Expiration Date            Security Code

    ______________________________________________
    Signature

Standard Shipping UPS Parcel Post	$ 12.00
Priority 2nd Day, COD, Offshore Zip Codes AK, HI	Call for Price

5.5% WI Sales Tax non food items only
$ TOTAL

Comments:

NORTHWESTERN COFFEE MILLS 30950 Nevers Road, Washburn, Wisconsin 54891 phone: 800-243-5283 local: 715-373-2212 fax: 715-373-0072

NORTHWESTERN COFFEE MILLS
30950 Nevers Road, Washburn, Wisconsin 54891
phone: 800-243-5283 local: 715-373-2212 fax: 715-373-0072