APPLESOURCE ORDER FORM

MY ORDER:

Name  
Address In case we have questions about your order:
Address YOUR DAYTIME PHONE
City, State, Zip YOUR E-MAIL ADDRESS

PAYMENT METHOD (circle one)

Check (Payable to Applesource)
VISA Card #
MASTERCARD Exp. Date: Sig

SHIP TO MY ADDRESS

ITEM SHIPPING DATE* PRICE
     
     
     
TOTAL  
* SHIPPING DATE: For each item specify:

C - Christmas
T - Thanksgiving
ASAP - First shipping date is Oct. 27. Please allow 2 weeks for us to process your order
OTHER DATE - First shipping date is Oct. 27. Give approximate date you want the apples to arrive. Let us know if the date is critical (for a party, birthday, etc.).

GIFT LIST

Gift Address #1

Name if address is a PO Box or a Rural Route
Address Addressee's Phone Number
Address  
City, State, Zip GREETINGS FROM:
ITEM SHIPPING DATE* PRICE
     
     
TOTAL  

Gift Address #2

Name if address is a PO Box or a Rural Route
Address Addressee's Phone Number
Address  
City, State, Zip GREETINGS FROM:
ITEM SHIPPING DATE* PRICE
     
     
TOTAL  

Gift Address #3

Name if address is a PO Box or a Rural Route
Address Addressee's Phone Number
Address  
City, State, Zip GREETINGS FROM:
ITEM SHIPPING DATE* PRICE
     
     
TOTAL  

ORDER SUMMARY

Total to my address  
Total Gifts  
Shipping*  
GRAND TOTAL  

* Shipping - All prices include FREE SHIPPING to Continental U.S. For shipping to Canada, Alaska or Hawaii add $8.00 per 12-count box.

APPLESOURCE, 1716 Apples Road, Chapin, IL, 62628
FAX: 217-245-7844

OUR GUARANTEE
We try our best to please you.
If something goes amiss, call or write.
We'll make it right.