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: $27.00/2-1 lb. bags

Coffee Club 1: $24.50/2-1 lb. bags mtly.

Coffee Club 3: $46.00/4-1 lb. bags mtly.

Bulk: $53.50/1-5 lb. bag

Coffee Club 2: $36.00/3-1 lb. bags mtly.

Coffee Club 4: $47.00/1-5 lb. bag mtly.

Coffee

Bean

Quantity

COLOMBIAN EXCELSO
High grown, full-bodied and mellow with balanced acidity and slight carmelly flavour

whole
grind

MISSIONARIES BLEND
Full flavour with pleasing complexity and aftertaste. A great way to start your day

whole
grind

PREMIUM DARK ROAST
Rich and smooth with dark chocolate-like overtones and soft smoky finish

whole
grind

ORGANIC DECAF
A decaffeinated coffee like you have never tasted - smooth, sweet and full-flavoured

whole
grind

Note:
Extra $1.00 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

Print Card Holders Name

Card Number

Expiry Date

Prices include shipping.

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 Option:
If you are interested in joining our Coffee Club, select the appropriate option above. 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 options, 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.