Information required for purchase of green Kona Coffee:
Please print, fill out, then fax this form to 1 808 322-4008
Thanks for your order.
Desired products: ______________________________________________________
Name of principal: _____________________________________________________
Name of business: _____________________________________________________
Address: ____________________________________________________________
___________________________________________________________________
___________________________________________________________________
Phone number: _______________________________________________________
Credit card number: ___________________________________________________
Credit card expiry date: ________________________________________________
Credit card number: ___________________________________________________
Method of shipping desired: _____________________________________________
__________________________________________________________________
Date of shipping desired: _______________________________________________
Signature for personal guarantee of payment: ________________________________
Please print, fill out, then fax this form to 1 808 322-4008
Thanks for your order.