PRINTABLE ORDER FORM

Use your browser's "Print" command to print a hard copy of this form.  Use it as a worksheet prior to calling in your order at (800) 572-0624, or fill it in and fax your order to (505) 237-8182 or mail it to us: New Mexico Pinon Coffee Company, 4431A Anaheim Avenue NE, Albuquerque, NM  87113  USA.

Name:	_____________________________________________
Billing Address:	_____________________________________________
City, State, Zip:	_____________________________________________
Phone:	(____) ____ - __________
Email:	_____________________________________________
Ship to Name (if different):	_____________________________________________
Address:	_____________________________________________
City, State, Zip:	_____________________________________________
Phone:	(____) ____ - ___________ (in case of delivery issues)

 

Qty	Item No. (if available)	Flavor	Description	Price Each	Total Price
__	______	________	____________________________	_____	_____
__	______	________	____________________________	_____	_____
__	______	________	____________________________	_____	_____
__	______	________	____________________________	_____	_____
__	______	________	____________________________	_____	_____
__	______	________	____________________________	_____	_____
				Sub Total	_____
(Please Add Appropriate Amount From Shipping Chart Below)				Shipping	_____
** For orders placed within New Mexico add 6.875% sales tax.				Sales Tax	_____
				TOTAL	_____

Orders up to $20 - $7.50
$20.01 to $30.00 - $8.50
$30.01 to $50.00 - $9.50
$50.01 to $75.00 - $10.95
$75.01 to $100.00 - $12.95
$100.01 to $150.00 - $19.95
$150.01 to $200.00 - $24.95
$200.01 to $300.00 - $34.95
Over $300.00 FREE SHIPPING
 

Method of Payment:
Check/Money Order (payable to New Mexico Pinon Coffee Company (U.S. Funds)
     (When paying by check or money order, your check or money order must be received by us before we
     can ship the requested items)
Visa - MasterCard - American Express - Discover
Credit Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp Date __ / __
Your Name, as shown on credit card__________________________________________
Billing Address _________________________________________________________
Signature ___________________________________________

go back