Fax Order Form
Licensed and Bonded Citrus Fruit Dealer
PO Box 453
Ocean Grove, NJ 07756
phone 732-425-4085
FAX ORDER FORM
FAX to: 732-774-1889
Use your browsers print button to print this form and fax to us at the above fax number
Please Print
Your Name _________________________________________________________________
Firm Name ________________________________________________ *AFD#____________
Address____________________________________________________________________
City__________________________________State________________Zip_______________
Telephone (________)_________________________________________________________
E-Mail______________________________________________________________________
*Affinity Program Discount Code
PLease ship to me:
Will someone be at home between 8am - 5pm to accept delivery? __ Yes __ No, if no there is an additional charge of $3.00 to hold the fruit so it will not freeze being left on the doorstep.We are not responsible if it spolis or freezes if no one is home.
Shipping date __ Thanksgiving __Christmas __Hanukkah __Easter __Passover __When Available
(if no date is requested we will ship upon first availablity)
Please allow 7-10 days for delivery. Sorry no shipments outside the continental U.S.A or to California, Arizona, Texas, and Louisiana. Shipping included in all prices.
Payment Methods
__ Check __ Visa __Mastercard
Card#_______________________________ Exp Date_________ SIC code ________
Signature______________________________________________________________
Ship Gift Box #1 to:
Your Name _________________________________________________________________
Firm Name _________________________________________________________________
Address____________________________________________________________________
City__________________________________State________________Zip_______________
Telephone (________)_________________________________________________________
E-Mail______________________________________________________________________
___ Do not leave at door if no one answers. Sign for delivery add $3.00 per delivery. Jersey Shore Citrus is not responsible if no one is home when the fruit is delivered and the fruit freezes and spoils.
Shipping date __ Thanksgiving __Christmas __Hanukkah __Easter __Passover __When Available
Gift card to read_______________________________________________________________
____________________________________________________________________________
Ship Gift Box #2 to:
Your Name _________________________________________________________________
Firm Name _________________________________________________________________
Address____________________________________________________________________
City__________________________________State________________Zip_______________
Telephone (________)_________________________________________________________
E-Mail______________________________________________________________________
___ Do not leave at door if no one answers. Sign for delivery add $3.00 per delivery. ersey Shore Citrus is not responsible if no one is home when the fruit is delivered and the fruit freezes and spoils.
Shipping date __ Thanksgiving __Christmas __Hanukkah __Easter __Passover __When Available
Gift card to read_______________________________________________________________
____________________________________________________________________________
Order Summary
My order ___________________
Gift #1 ___________________
Gift#2 ___________________
Total ___________________
