CookiePots Fax Order Form

Fax Number - 419-824-9792
(Feel free to print as many pages of this form as you need - Once processed, a complete receipt with shipping charges will be sent to you via the e-mail address that you provide below)

ORDERED BY:

Your Name__________________________________________________________________________

Company___________________________________________________________________________

Billing Address  of Credit Card__________________________________________________________

Address ___________________________________________________________________________

City______________________________________________  State_______ Zip__________________

Phone (_____)__________________  E-Mail Address: _______________________________________

Credit Card # ____________________________________Exp.________  Authorization Code: _______

Print Name: _________________________________________________________________________

Signature ___________________________________________  Date __________________________

********************************************************************************************************************
DELIVER TO:

Name______________________________________________________________________________

Company___________________________________________________________________________

Address  ___________________________________________________________________________

Address ___________________________________________________________________________

City______________________________________________  State_______ Zip__________________

Phone _______________________  E-Mail Address: _______________________________________

Gift Ordered :  ________________________________________________ _____________________

Enclosure card to read: __________________________________________________________________________

Amount $ ____________________  Preferred Delivery Date: ____________ (or ASAP)
(not including tax & delivery charges) 

Circle Delivery Method:  UPS Ground ($9.50, 1-5 business days), 3-Day Fed Ex ($13.45 - arrives 3 business days later) 2-Day Fed Ex ($21.75 - arrives 2 business days later), Next Day Fed Ex ($36.95  arrives next business day M-F) For same day shipping, order must be placed before 2:00PM EST)

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~  ~  ~  ~  ~  ~  - - - - ~  ~  ~  ~  - - - - ~  ~  ~  ~ 

DELIVER TO:

Name______________________________________________________________________________

Company___________________________________________________________________________

Address  ___________________________________________________________________________

Address ___________________________________________________________________________

City______________________________________________  State_______ Zip__________________

Phone _______________________  E-Mail Address: _______________________________________

Gift Ordered :  ________________________________________________ _____________________

Enclosure card to read: __________________________________________________________________________

Amount $ ____________________  Preferred Delivery Date: ____________ (or ASAP)
(not including tax & delivery charges) 

Circle Delivery Method:  UPS Ground ($9.50, 1-5 business days), 3-Day Fed Ex ($13.45 - arrives 3 business days later) 2-Day Fed Ex ($21.75 - arrives 2 business days later), Next Day Fed Ex ($36.95  arrives next business day M-F) For same day shipping, order must be placed before 2:00PM EST)

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~  ~  ~  ~  ~  ~  - - - - ~  ~  ~  ~  - - - - ~  ~  ~  ~ 

DELIVER TO:

Name______________________________________________________________________________

Company___________________________________________________________________________

Address  ___________________________________________________________________________

Address ___________________________________________________________________________

City______________________________________________  State_______ Zip__________________

Phone _______________________  E-Mail Address: _______________________________________

Gift Ordered :  ________________________________________________ _____________________

Enclosure card to read: __________________________________________________________________________

Amount $ ____________________  Preferred Delivery Date: ____________ (or ASAP)
(not including tax & delivery charges) 

Circle Delivery Method:  UPS Ground ($9.50, 1-5 business days), 3-Day Fed Ex ($13.45 - arrives 3 business days later) 2-Day Fed Ex ($21.75 - arrives 2 business days later), Next Day Fed Ex ($36.95  arrives next business day M-F) For same day shipping, order must be placed before 2:00PM EST)