Mountain Valley Estate Kona Coffee
100% Pure Kona Coffee
Order Form
Print this form to order by fax
OR
Click here for
an acrobat file of this form
| 100% Kona Coffee Roast |
Size |
Quantity |
Price* |
Sub-Total |
| MEDIUM |
16 OZ |
______ |
$30.00 |
$___________ |
| FULL CITY |
16 OZ |
______ |
$31.00 |
___________ |
| FRENCH |
16 OZ |
______ |
$32.00 |
___________ |
| MEDIUM |
8 OZ |
______ |
$19.00 |
___________ |
| FULL CITY |
8 OZ |
______ |
$19.50 |
___________ |
| FRENCH |
8 OZ |
______ |
$20.00 |
___________ |
| SPECIALS |
Roast
|
Quantity
|
|
|
| 5-LB Bulk 100% Kona |
______ |
______ |
$140.00 |
$___________ |
| |
|
|
|
| |
|
TOTAL |
$___________ |
JAVA CLUB: Get
it at a discounted rate! Check Yes below:
| Join Java Club? Check |
Schedule of Delivery
Circle or write in |
Personalized: ____________________ |
Day of month to send
(ie: the 15th) |
| YES! _____ |
Monthly |
Every other month |
Quarterly |
|
____________ |
*All prices include shipping within the USA. All
International orders are handled on an individual basis.
Shipping Info:
Name: _______________________________ Your Email: _______________
Address: ______________________________________________________
City/State/Zip: ______________________________________
Circle one: Day / Night - Phone:
______________________________________
Send check or money order to address below or best security FAX us with
credit info below
Credit Card Info:
Circle one: MC / VISA / Amex / Discover
Card Number:
______________________________________
Exp Date: ______________ Name on Card: ___________________________
Signature: ______________________________________
Please allow up to 7-10 days for delivery.
Please check your email within 3 days of faxing
Print this form to order by fax
Email:
sales@mackkonacoffee.com
Mountain Valley Estate 100% Kona Coffee
P.O. Box 154
Honaunau, HI 96726
Phone: Local (808) 328-9703
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