Hot Rod Coffee Order Form

NAME:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE#:

E-Mail Us at:      HotRodCoffee@Pacbell.Net

CHECK OR MONEY ORDER MADE PAYABLE TO:  THE HOT ROD CAFE

MAIL TO:

         THE HOT ROD CAFE
         1314   ROLLINS  ROAD
         BURLINGAME,  CA  94010

FAX   ORDERS TO :

         THE HOT ROD CAFE
         (650)-340-9473
 

CREDIT CARD:

MASTERCARD     or      VISA

CALL:  (650)-348-8269
CREDIT CARD NUMBER:
  |  |  |  |  |  |  |   |  |  |  |  |  |  |  |  |
EXPIRATION DATE:     |  |  |  |
  SIGNATURE:________________
   
QTY.                 DESCRIPTION

PRICE:

 

3 POUND GIFT PACK,

1 LB OF EACH BLEND:

     $36.00 per gift pack

CHOOSE:   WHOLE BEAN OR DRIP GRIND

     WHOLE BEAN ____        ...or...

     DRIP GRIND ____

SHIPPING CHARGES:    

     $9.00 per gift pack             
  TOTAL = $45.00 PER 3 lb. GIFT PACK

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