Cheese Order
 
Cheese
Number of lbs.
Price per lb.
Total
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
 
Shipping Charges
Merchandise Total
Delivery Charges
Up to $ 30.00
$ 5.95
$ 30.01 to $ 50.00
$ 7.95
$ 50.01 to $ 90.00
$ 9.95
$ 90.01 to $ 140.00
$ 14.95
$ 140.01 to $ 200.00
$ 19.95
$ 200.01 to $ 300.00
$ 31.75
Over $300.00 add 9% of merchandise total.
*
5.00
*

$     Total

Handling

Shipping

 

$
Cheese Order Total

 
Ship to arrive:     O Now     O Christmas     O Other Date ______________
 
Please remember to transfer the Cheese Order Total to page 3 of this form and complete the Ordered By information.
Page 1
Gift Orders
 
Gift Order #1 Gift # ________ Quantity ______ Amt $ ___________
Ship to: __________________________________________________________________________________________
Street: __________________________________________________________________________________________
City: _____________________________________________ State: __________________ Zip: ___________________
Ship to arrive: O Now   O Christmas   O Other Date ______________________________________________________
Card to read: _____________________________________________________________________________________
_________________________________________________________________________________________________
Gift Order #2 Gift # ________ Quantity ______ Amt $ ___________
Ship to: __________________________________________________________________________________________
Street: __________________________________________________________________________________________
City: _____________________________________________ State: __________________ Zip: ___________________
Ship to arrive: O Now   O Christmas   O Other Date ______________________________________________________
Card to read: _____________________________________________________________________________________
_________________________________________________________________________________________________
Gift Order #3 Gift # ________ Quantity ______ Amt $ ___________
Ship to: __________________________________________________________________________________________
Street: __________________________________________________________________________________________
City: _____________________________________________ State: __________________ Zip: ___________________
Ship to arrive: O Now   O Christmas   O Other Date ______________________________________________________
Card to read: _____________________________________________________________________________________
_________________________________________________________________________________________________
Gift Order #4 Gift # ________ Quantity ______ Amt $ ___________
Ship to: __________________________________________________________________________________________
Street: __________________________________________________________________________________________
City: _____________________________________________ State: __________________ Zip: ___________________
Ship to arrive: O Now   O Christmas   O Other Date ______________________________________________________
Card to read: _____________________________________________________________________________________
_________________________________________________________________________________________________
Gift Order #5 Gift # ________ Quantity ______ Amt $ ___________
Ship to: __________________________________________________________________________________________
Street: __________________________________________________________________________________________
City: _____________________________________________ State: __________________ Zip: ___________________
Ship to arrive: O Now   O Christmas   O Other Date ______________________________________________________
Card to read: _____________________________________________________________________________________
_________________________________________________________________________________________________
Additional orders may be written on multiple print outs of this form.
Page 2

 

 

 

 

Ordering Information
 
Ordered by:
Name: __________________________________________________________________________________________
Street: __________________________________________________________________________________________
City: _____________________________________________ State: __________________ Zip: __________________
Daytime Telephone ( ________ ) _____________________________________________________________________
 
Ship these gifts to my address listed above:
Gift # ________ Quantity ______ Amt $ ___________ Gift # ________ Quantity ______ Amt $ ____________
Ship to arrive: O Now   O Christmas   O Other Date ______________________________________________________

Thank you for your order.

Payment Method:

O Enclosed is my check or money order payable to:
  Paoli Cheese

Charge my order to:
   O Mastercard   O Visa
Cheese Order Total
(including shipping and handling.)
 $
Gift Order Total
(including shipping and handling.)
 $
Rush Delivery or
Custom Box Charges (if any).
 $
Grand Total
 $

 
Credit Card #
Expiration Date

Month / Year

 

Authorized Signature _______________________________________________________________________________

 
Page 3