
Canaan, New Hampshire
Order Form - FAX Number 603-523-7073
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| First Name: |
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| Last Name: |
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| Mailing Address: |
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| Phone: |
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Fax: |
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| Cell: |
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E-mail: |
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| Product |
Quantity |
| Pint, (16 ounces), $20.00 |
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| Quart, (32 ounces), $30.00 |
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| Half Gallon, (64 ounces), $42.00 |
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| * Prices include Shipping, Continental U.S. |
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Additional Information
Including delivery address(es) and/or gift(s) message(s).
If addditional space is need, attach more pages.
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Payment Information
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| Payment Method: |
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Personal Check ( )
Money Orders ( ) |
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Please provide the following information
if you are paying with a Credit Card: |
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Card Number: |
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Expiration Date: |
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All payments are to be made in advance in U.S. funds. We do not ship
C.O.D. Mastercard and Visa
cards are accepted. Checks
or Money Orders can be mailed to:
Clark Hill, Inc.
P.O. Box 20
Canaan, NH 03741, USA
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