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FAX COVER SHEET
* Pot O' Gold Order *
To:
Pot O' Gold, Inc.
To Fax Number:
425-637-5083
From:
From Fax Number:
Number of Pages Faxed:
CUSTOMER INFORMATION
Contact Person:
Please Contact Me By:
Please Select
Email
Phone
Fax
Contact Phone Number:
(Required)
Phone Extension:
Contact E-mail:
(Optional)
Payment Option:
Please Select
Pot O' Gold Account
Credit Card
Check or Money Order
* We will contact you to retrieve any account numbers, billing information, and shipping information *
Please type in all the appropriate information and print out this page for faxing in your order. Thank you.
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Page updated on:
03.01.05
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Pot O' Gold Coffee Service. All rights reserved.