Call (228) 588-3060

Order Form

Print cut along lines and mail order form along with payment.

Qty.

______ per Bottle x $5.00

______ per Case (16) x $80.00

Qty.

______ per Sales Display Box x $10.00

Mail To:

Pineolene Products LLC

P.O. Box 670

Hurley, MS 39555

Ship To:

Name

Address

City

State                                           Zip

______________________________________________

___________________

Sign Here

_______________________________________

X

Note: Shipping and Handling $5.00 per Package

______________________________________________

______________________________________________

___________________

Please include phone number with order.

(              )   ______________________

Total Amount Enclosed $ ______________

Or Please call us at (228) 588-3060 and place your order direct.

Accepted: Check or Money Order

Thank you for your order.

Wholesale

Retail

Qty.

______ per 3-Pack x $30.00

(Includes Shipping & Handling)

Pineolene Products LLC

(228) 588-3060   P.O. Box 670   Hurley, MS 39555
Email  vernonpierce@pineolene.com     Copyright 2009     Site by Pardue Consulting