Please print this form
Mail and Fax Order Blank
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How to order: 1. Fill in the order blank as indicates. 2. Include Check, Money Order, or Credit Card Information. No COD's. 3. Mail or Fax to: Seguin's House of Cheese, Highway 41, Marinette, WI 54143, Fax: 1-715-735-3824 |
YOUR NAME ______________________________________________
STREET __________________________________________________
CITY ___________________________ STATE ____ ZIP ___________
PHONE ________________________
| Gift No.________ Amt $________ ShipTo___________________________ Street___________________________ City_______________State___ Zip____ Gift Card [ ] Message_______________ ________________________________ [ ] For Christmas Delivery [ ]For Delivery On __________________ Gift No.________ Amt $________ Gift No.________ Amt $________ |
Gift No.________ Amt $________ ShipTo___________________________ Street___________________________ City_______________State___ Zip____ Gift Card [ ] Message_______________ ________________________________ [ ] For Christmas Delivery [ ]For Delivery On __________________ Gift No.________ Amt $________ Gift No.________ Amt $________ |
[ ] Check or [ ] Money Order
[ ] Mastercard, [ ]Visa, [ ] Discover, or [ ] American Express
Account Number ___________________ Exp. Date________