Buyer Name            _________________________________  Phone ___________________

 

Email _______________________________________

 

Payment   Cash     Check      VISA      Master Card     Credit    Debit

 

Card Number______________________________________  Expiration Date _________

 

Card Authorization _____________________   By ________________

 

Order Taken By ______________________   Date Ordered ________________

 

Date Shipped     _________________            Shipped By   ________________

 

 

Delivery Address                            _____________________________________

 

Date to Ship:                                    _____________________________________

 

_________________                    _____________________________________

                        City                                          State                 Zip

 

Method of Shipment:         UPS______              Other: _______________

(On UPS shipping charges will be actual UPS charge.  On other methods of shipment there may be a handling charge.)

 

Ground - 3 Day Select – 2 Day – 2 Day AM – Next Day  (Circle One)

 

 

# Units	Size	Cheese		Price	Cost
Subtotal
Shipping
Total for this delivery address

 

If you would like a note with the shipment please write here what you want on it:

 

 

 

If you would like more than one shipment on the same payment, you need only fill in the top portion once.

There will be a $20.00 charge for returned checks.

Thank you for your order!