ORDER FORM - TEA STICKS by leader6

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									                    Wholesale

                    ORDER FORM - TEA STICKS
                    DeR Coffee and Tea Co.                                      GST # 87171 0141 RT0001                                  Order Date
                    10756 180th Street NW Edmonton, AB T5S 2S4                                                                           # of Pages
                    Ph:(780)-444-2376      Fax: (780)-489-5266 Toll Free: 1-(866)-444-2379
www.dercoffee.com
                    Bill To                                                      Contact                                                 Delivery Instructions
                    Address                                                                     Postal Code:
                    Phone       (       )                                             Fax (      )                                       Pick - Up
                                                                                                                                         Greyhound (Stn to Stn)
                    Gourmet Ice Tea Collection - Each box contains 12 packets that make two 8 oz servings. Add to                        Other ______________________
                    your 500 ml bottled water and experience a refreshing taste sensation. Sweetened with Splenda… All of
                    the flavour with none of the calories.

                                                                        12 packets/box        12 boxes/case                              FOB Edmonton
                                        Tea Sticks                        $3.25/box             $39/case          Total Cost             Trucking Co.
                                                                          # of Boxes           # of Cases                                Account #:
                                                                                                                                         Phone #:
                    Ceylon Tea with Lemon Mint (40 g)

                    Black Tea with Cranberry Apple (40 g)

                    White Tea with Sun Ripened Peach (40 g)

                    Green Tea with Cucumber & Lemon (40g)

                    Oolong Tea with Tangerine (40 g)

                    Darjeeling Tea with Watermelon (40 g)

                    Oolong Tea with Pomegranate (40 g)

                                                                                       Product Sub Total
                    Drinking more water is the key                                    Shipping Sub Total
                    to good health. These ICE
                    TEA MIXES make it easy.                                                              GST

                                                                                                    TOTAL

                    Method of Payment         [ ] Visa    [ ] M/C   [ ] Debit    [ ] Cheque

                    Account #   l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l   Expiry Date        l_l_l l_l_l
                    Card Holder Name (print)                                                                   All orders must be PREPAID
                                                                                                               No minimum orders on any items
                    Card Holder Signature                                                                      We accept Debit Cards, Visa, Mastercard or Cheque

								
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