LYSANDER'S PRODUCTS ORDER FORM Page 1 of 2  (mail or fax BOTH pages together)
Section 1: Enter Billing and Shipping Address
(We must verify all Billing information prior to shipping)
BILL TO:  
Name:
Address:
City:
State/Prov:
Zip/Postal:
Phone: (            )  ___________—_______________________

Your eMail:
   
 
 Order Date:  
click for
PAGE 2
SHIP TO (only if different from Bill To:)

Name:
Address:
City:
State/Prov:
Zip/Postal:
   



Section 2: Order Items Here  [PRINT PAGE 2 OF 2]
Ordering Instructions: Enter your order quantity in the space provided just left of the item. Multiply your order quantity by the price indicated and write the amount in the total column. Add totals. Place final quantity of items ordered and the final amount paid where indicated. Then, proceed to Sections 3 & 4. Additional charges on shipments to P.O. Boxes and C.O.D. deliveries may apply.
 
MINIMUM ORDER: $20.00 (mix & match)
(Minimum order is to one shipping location)

10% DISCOUNT OFF ENTIRE ORDER WHEN
ANY 12 OF THE SAME ITEM IS PURCHASED



Section 4: Payment
We accept all major credit cards, checks, and money orders.
DO NOT SEND CASH.
We accept all Major Credit Cards Circle
Card used
Visa Amex Mastercard Discover

Card Number:  
_ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _
Expiration Date:
_ _ / _ _

Print Name:
(as on Card)


Signature:
 
TOTAL from PAGE 2 #of ITEMS
FINAL QUANTITY
of ITEMS ORDERED > 
 
SUBTOTAL from PAGE 2  
SUBTOTAL of ORDER >
$ 0 0 0 . 0 0
Add $2.00 for deliveries to
P.O. Boxes (if applicable).
$ 0 0 2 . 0 0
Add $6.00 for all C.O.D.
deliveries (if applicable).
$ 0 0 6 . 0 0
UPS Ground Shipping
$ FREE 
FINAL ORDER TOTAL >
$ 0 0 0 . 0 0

Prices include UPS Ground
shipping and handling charges.
Prices effective since June 28, 1999
Last updated November 11, 2001
FAX or MAIL BOTH (2) PAGES (and Check or Money Order—no Cash, please) TO:
GENEVA FOODS, LLC  ·  119B Commerce Way  ·  Sanford, FL 32771  ·  FAX 407-323-4394