Hula Cookies Tin Order Form Click HERE To Print. Business Tel: (808) 243-2271 – Fax (808) 875-1638
Name of Person Ordering:
_________________________________________________________________________
Address: ___________________________________
City________________________State: _____ Zip___________
Phone: _____________________ Date of Order:______________
Date to Send Cookies:_____________
Credit Card Type (please check one): Visa _____ MasterCard
_____
Credit Card Number:
___________________________________________ Expiration Date: _______________
Name on Credit Card:
________________________________________________________________________
Please fax completed Order Form to: 875-1638
**When
ordering 5 or more tins in any combination you’ll receive an extra 10% Discount
**
Send to the following people: (prices below include
the S. & H. charge to the Mainland.
For Shipping & Handling in Hawaii- subtract $1.95
for 2 lb. Tin ($21.00) and $.50 for 1 lb. Tin ($13.75)
1.
Name:
_______________________________________________________
Address:
__________________________________City:______________________ State________ Zip:____________
2
lb. Tin - $22.95 ___ 1 lb. Tin -
$14.25 ___
(please check) Cookie Type: Assorted ___ Choc. Ast. ___ Fruit Ast.___
2.
Name:
_______________________________________________________
Address:
__________________________________City:______________________ State________ Zip:____________
2
lb. Tin - $22.95 ___ 1 lb. Tin - $14.25
___ (please
check) Cookie Type: Assorted ___ Choc. Ast. ___ Fruit Ast.___
3.
Name:
_______________________________________________________
Address:
__________________________________City:______________________ State________ Zip:____________
2
lb. Tin - $22.95 ___ 1 lb. Tin -
$14.25 ___
(please check) Cookie Type: Assorted ___ Choc. Ast. ___ Fruit Ast.___
4.
Name:
_______________________________________________________
Address:
__________________________________City:______________________ State________ Zip:____________
2
lb. Tin - $22.95 ___ 1 lb. Tin -
$14.25 ___
(please check) Cookie Type: Assorted ___ Choc. Ast. ___ Fruit Ast.___
5.
Name:
_______________________________________________________
Address:
__________________________________City:______________________ State________ Zip:____________
2
lb. Tin - $22.95 ___ 1 lb. Tin -
$14.25 ___
(please check) Cookie Type: Assorted ___ Choc. Ast. ___ Fruit Ast.___
6.
Name:
_______________________________________________________
Address:
__________________________________City:______________________ State________ Zip:____________
2
lb. Tin - $22.95 ___ 1 lb. Tin -
$14.25 ___
(please check) Cookie Type: Assorted ___ Choc. Ast. ___ Fruit Ast.___
7.
Name:
_______________________________________________________
Address:
__________________________________City:______________________ State________ Zip:____________
2
lb. Tin - $22.95 ___ 1 lb. Tin -
$14.25 ___
(please check) Cookie Type: Assorted ___ Choc. Ast. ___ Fruit Ast.___
8.
Name:
_______________________________________________________
Address:
__________________________________City:______________________ State________ Zip:____________
2 lb. Tin - $22.95 ___ 1 lb. Tin - $14.25 ___ (please check)
Cookie Type: Assorted ___ Choc. Ast. ___
Fruit Ast.___