Billing Address:
Name: ______________________________________________________
Address: ___________________________________________________
         ___________________________________________________
City: ____________ State:_____ Zip:_________________________
Phone (optional): __________________________________________
 

Shipping Address: (if different than above)
Name: ______________________________________________________
Address: ___________________________________________________
         ___________________________________________________
City: ____________ State:_____ Zip:_________________________
Phone (optional): __________________________________________

Order Date:_____________
$ Enclosed:_____________

_Check     _Cash      _Money Order
_Visa   _Master Card  _Discover  _American Express

#
Expiration Date:_________________________________________________
Bank Issuing Card:_______________________________________________
I can be reached during the day at:______________________________

Note: All prices include ground shipping and handling

Quantify	Item	Unit Price	Amount
_	Jar Wild Blueberry Snack Sauce	$6.00	_
_	Case (12 Jars) Wild Blueberry Snack Sauce	$36.00	_
	Jar Rhubarb-Strawberry Fruit Sauce	$6.00
	Case (12 Jars) Rhubarb-Strawberry Fruit Sauce	$36.00
		TOTAL	________

Signature:_____________________________________

Mail  To:
Trim Foods, Inc.
Order Dept.
274 Cabot Court
Fishkill, NY 12525