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Captain Order Form - PDF by xcv19621

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									2 0 1 0                 R U M                 C A K E                   O R D E R                         F O R M
CAPT. BRECK’S                              Brecksville Cake Co. • 1878 Owensfield Dr., Charlottesville VA 22901
                                           Phone: 434.971.6573 • Fax: 434.971.7125
   RUM CAKE                                Web: www.captainbreck.com • Email: captainbreck@comcast.net

____________________________________________________________________________________       Available in two sizes
Order placed by (Name)
                                                                                             and four flavors
____________________________________________________________________________________
Company Name
                                                                                       FLAVOR ORDERING CODES:
____________________________________________________________________________________   • Classic = C
Street Address
                                                                                       • Banana Walnut = BW
____________________________________________________________________________________   • Chocolate Raspberry = CR
City / State / Zip
                                                                                       • Piña Colada = PC
____________________________________________________________________________________
Phone (Day / Evening)
                                                                                          PLEASE PRINT ALL
____________________________________________________________________________________     ORDER INFORMATION
May we contact you by Email? (Email address)

         Recipient’s Name, Address & Gift Message Information:                         Quantity   M                             Flavor   M              Total   M



____________________________________________________________________________________     ______ Large @ $23.00/box ..........________ .......... $ ____________
Send to (Name)                                                                                  One gift boxed 1 1/2 lb. cake
____________________________________________________________________________________     ______ Small @ $24.00/box ..........________ .......... $ ____________
Company Name                                                                                    One box of four individually gift boxed
____________________________________________________________________________________            5 oz. mini-cakes - all same flavor
Street Address                                                                           ______ Small @ $24.00/box ....................................$ ____________
____________________________________________________________________________________            One box of four individually gift boxed
City / State / Zip                                                                              5 oz. mini-cakes - one of each flavor

____________________________________________________________________________________
                                                                                                  Shipping @ $8.00/box* ...............................$ ____________
Gift Message                                                                                     *Additional charges apply
                                                                                                 to shipments outside the United States
____________________________________________________________________________________
From                                                                                              Ship to be received by (date): ________________________


____________________________________________________________________________________     ______ Large @ $23.00/box ..........________ .......... $ ____________
Send to (Name)                                                                                  One gift boxed 1 1/2 lb. cake
____________________________________________________________________________________     ______ Small @ $24.00/box ..........________ .......... $ ____________
Company Name                                                                                    One box of four individually gift boxed
____________________________________________________________________________________            5 oz. mini-cakes - all same flavor
Street Address                                                                           ______ Small @ $24.00/box ....................................$ ____________
____________________________________________________________________________________            One box of four individually gift boxed
City / State / Zip                                                                              5 oz. mini-cakes - one of each flavor
                                                                                                  Shipping @ $8.00/box* ...............................$ ____________
____________________________________________________________________________________
Gift Message                                                                                     *Additional charges apply
                                                                                                 to shipments outside the United States
____________________________________________________________________________________
From                                                                                              Ship to be received by (date): ________________________


____________________________________________________________________________________     ______ Large @ $23.00/box ..........________ .......... $ ____________
Send to (Name)                                                                                  One gift boxed 1 1/2 lb. cake
____________________________________________________________________________________     ______ Small @ $24.00/box ..........________ .......... $ ____________
Company Name                                                                                    One box of four individually gift boxed
____________________________________________________________________________________            5 oz. mini-cakes - all same flavor
Street Address                                                                           ______ Small @ $24.00/box ....................................$ ____________
____________________________________________________________________________________            One box of four individually gift boxed
City / State / Zip                                                                              5 oz. mini-cakes - one of each flavor

____________________________________________________________________________________
                                                                                                  Shipping @ $8.00/box* ...............................$ ____________
Gift Message                                                                                     *Additional charges apply
                                                                                                 to shipments outside the United States
____________________________________________________________________________________
From                                                                                              Ship to be received by (date): ________________________


                                                         PLEASE REMIT YOUR CHECK WITH YOUR ORDER                           TOTAL


Thankyou!
                                                         Check made payable to Brecksville Cake Company                    AMOUNT ........ $ ______________
                                                         Please copy this Order Form for larger orders
                                                         OR provide us with a list (preferably typed) of                   DATE __________________________
                                                         names, addresses & individual gift messages.

RE __________________ PD _____________________ AC ______________________ SC ______________________ MA ______________________

								
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