ORDER FORM


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ORDERED BY:


Name
Mailing Address
Shipping Address, If Different
City                                                                         State          0                 Zip
Daytime Phone

GIFT ORDER A / SHIP TO:


Name of Gift Recepient
Shipping Address
City                                                                         State          0                 Zip
Message, Due Date

GIFT ORDER B / SHIP TO:


Name of Gift Recepient
Shipping Address
City                                                                         State          0                 Zip
Message, Due Date


Stock
No.
Qty. Gift?
A,B
                  Description                   Unit
Price
Total
Price
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           


      SHIPPING CHARGES      
If your total is ADD
$0 - $10 $3
$10.01-$20 $5
$20.01-$30 $6
$30.01-$40 $7
$40.01-$65 $8
$65.01-$100 $10
over $100 $12
Outside USA Plus Extra $5
            TOTAL CHARGES            
Total Costs (add total prices from above)            
Shipping Charges (see table)            
GRAND TOTAL            









METHOD OF PAYMENT
 
 
Charge to:
  • Check Enclosed
  • Money Order
  • Visa
  • American Express
  • Mastercard
Credit Card #
Expiration Date
Signature


MAIL COMPLETED ORDER FORM TO:
 
Firehouse Hot & Spicy Shoppe
The On-Line Store of White Oak Deli
1502 Lincoln Way, McKeesport, PA 15213 USA

Toll-Free 1-888-347-3347