Josephs-Wayside Market |
Print form and mail or fax to: Josephs-Wayside
Market Naples NY 14512 Fax:
(585) 374- 5955 www.josephs-wayside.com |
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FAX / MAIL ORDER FORM |
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Please PRINT In BLOCK LETTERS Please process my
order for the items requested. MasterCard__ Visa__
Discover__ American Express__ Card Number _____________________________________ Exp Date _________ Signature_______________________
Comment ________________________________________ ________________________________________________ Email Address
____________________________________ |
Name_____________________________________________ Company__________________________________________ Address __________________________________________ City/State/Zip ______________________________________ Daytime Phone _____________________________________ Credit Card Billing Address (If different than above): Name on Card______________________________________ Address__________________________________________ City/State/Zip ______________________________________ Daytime Phone _____________________________________ |
| Item # | Product Name / Description | Qty. | Unit Price | Total |
| Merchandise Total | |
| Shipping & Handling | |
| Sales Tax (8% sales tax for shipments within California / 5.2% sales tax for shipments within Colorado) |
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| Total Amount Enclosed |
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Orders . Status of an Order / Customer Service |