--------------------------------------------------------------------------------
Hamilton Hops and Grapes
"Home of the largest selection of products to choose from on
Vancouver Island"
--------------------------------------------------------------------------------
Email Us
------or print a FAX ORDER FORM
Instructions:
1. "Print this Form" button above to print out a hardcopy.
2. Fill out the form completely and fax to Hamilton Hops and Grapes
at: (250) 388-4544.
3. A representative of Hamilton Hops and Grapes will contact you
as soon as possible, via the communications method
you indicate below, to confirm your order and process your purchase
information.
Product(s): Shipping
will be determined depending on your volume and destination to be
shipped. (if you wish we can ship via Canada Post.)
(All
pricing will be quoted upon request)
_________ ___________ ______________________
_________ ___________ ______________________
_________ ___________ ______________________
Purchasing
Information
I wish to pay by: Check
___ Money Order ___ Credit Card ___
(If paying by check or money order, your order will be shipped upon
receipt of your check or money order)
Credit Card Information: (if chosen as
payment method)
Cardholder's Name: ______________________ Credit Card: (circle one)
Visa - MasterCard
Card Number: _________________________Expiration Date: __________
Cardholder Signature: ______________________
|
Contact
Information
First Name: _________________Last Name: _________________
Company: _________________E-mail Address: _______________
Telephone: __________________________
Address: _________________________
City: ___________________ State/Province: ______________
Country: ______________Zip/Postal Code: __________
|
Ship
to Information
First Name: ________________Last Name: ______________
Company: __________________________
Telephone: __________________________
Address: _________________________
City: ___________________State/Province: _______________
Country: __________Zip/Postal Code: ____________
|
Communication
Preference: (circle one) Telephone - E-mail -
Fax
Best time to be reached: Between
__________ (AM | PM) and __________ (AM | PM)
Other Services: Do you wish to be
contacted for our Montly Specials: Yes - No (circle
one ) E-mailing /Fax
