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Pleasant Acres Jams &
Jellies |
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2027 Hwy 454 |
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Pineville, LA
71360 |
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Ph:
888-738-5109 |
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Fax:
480-393-5730 |
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Email:
sales@jelliesandjams.com |
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| FAX ORDER
FORM |
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| Please fill out
all applicable information and fax order to
480-393-5730. |
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| Customer
Billing Information (Must be the
same as billing address of credit
card.) |
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Name:
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Address:
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| City: |
State: |
Zip Code: |
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| Fax: |
Email: |
Phone: |
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| CREDIT CARD
INFORMATION |
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Name as appears on credit
card:
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Card Type (Circle One):
VISA
MC
AMEX
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Card
Number:
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Expiration Date:
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CW2 Code:
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| Shipping
Address (if different than billing
address): |
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Name:
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Address:
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| City: |
State: |
Zip Code: |
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| Authorized
Signature (Must be signed before we will process your
order): |
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| Items Ordered: |
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| Description |
Price
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Quantity |
Total Price |
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Subtotal |
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Sales Tax (4% for Louisiana residents
only) |
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Total Amount |
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| The following
shipping costs are for Ground shipments only within the
continental US. |
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| Up to
$9.99
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$8.95 |
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| $10.00-$49.99 ----
$12.95 |
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| $50.00-$99.99 ----
$18.95 |
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| $100.00-$199.99 ----
$24.95 |
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| $200.00 and
up
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$35.95 |
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| Call or e-mail
for shipping rates outside the continental US (Alaska
and Hawaii). |
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| For expedited
shipments, please select your preferred method of
delivery: |
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| Next Day Air |
2nd Day Air |
3 Day Select |
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| We will calculate your
total and fax or email the total back to you for your
approval. |
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| Thank you for shopping
with Pleasant Acres Jams & Jellies! |
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