Coffee Online Order Form

Coffee Order in support of

_____________________________________
Name of Participant

Print and Fax or Mail to:
Coffee Online
40 Pennywell Road
St. John's, NL
Canada A1C2K9
Fax: 425-790-4088
Print Now!

Selection (Note: Currency is based on the Country at the Point of Sale.)

Regular: $21.98/2-1 lb. bags

Coupon (2lb): $19.48/2-1 lb. bags mtly.

Coupon (4lb): $35.96/4-1 lb. bags mtly.

Bulk: $47.00/1-5 lb. bag

Coupon (3lb): $28.48/3-1 lb. bags mtly.

Coupon (5lb): $40.50/1-5 lb. bag mtly.

Coffee

Bean

Quantity

HONDURAN FULL CITY ROAST

whole grind

HONDURAN FRENCH ROAST

whole grind

COLOMBIAN EXCELSO

whole grind

MISSIONARIES BLEND

whole grind

PREMIUM DARK ROAST

whole grind

ORGANIC DECAF

whole grind

Note:
ADD Extra $1.50 per pound for decaf.

SHIPPING INFORMATION: (Please print clearly)

Name
Street Address
City
Prov/State		Postal Code/Zip
Country		E-mail
Hm. Ph.	( )	Bus. Ph.	( )

For Credit Card Orders: Fill in the appropriate information.

Visa

MasterCard

3 Digit Security # _______

Print Card Holders Name

Card Number

Expiry Date

Select One
Please use another order form for additional orders.

Select Coffee
Mix and match your coffee, Whole or Grind and Quantity. Make sure you do not exceed the number of bags that is specific to your selection above.

For Coffee Club Coupons:
If you are interested in joining our Coffee Club, select the appropriate Coupon. For details check our website.

If you are paying by cheque, make it payable to IAM-Coffee Online. If you are choosing one of our Coffee Club Coupons, please enclose 12 post-dated cheques with your order form. The cheques should be post-dated for the first of each month.

Thank you
for your support.