Northern
Flavours
Gift Basket
Order Form
Please fill out
the following form and return it to Northern Flavours. Prepayment is required
before the order will be processed (We take Visa or MasterCard). When the
basket is completed you will be contacted by phone.
Last Name:
_____________________________ First Name: _______________
Street Address:
Home Phone:
____________ Work Phone: ____________ Fax: ___________
q
Small Basket – $19.99 q Large Basket – $39.99
q
Custom Basket: $____________
Choose a Theme (You
may choose more than one)
q Coffee q Tea q Loose Tea q Candy
Choose some possible products
q Ground Coffee (Tinq or Bagq): ____________________________________
q Loose Tea (Tinq or Bagq): _______________________________________
q Coffee Merchandise:
_____________________________________________
q Tea Merchandise:
_______________________________________________
q Candy: ________________________________________________________
q Hot Beverage Syrups:
_________________________
q Cider q Hot Chocolate
q Gift Certificate:
$______ q Free Beverage Card
q Other:
_________________________________________________________
Signed:
_______________________________ Date:
________________
Northern
Flavours Coffee House – Phone: 677-8281
Fax: 677-2584 email: flavours@mts.net