Purchase Request DATE:................................................

(Please Print)

Moons Coffee & Tea, LLC

 Ship To:

1605 Juan Tabo Blvd. NE, Ste F

.

Albuquerque, NM 87112 USA

.

Phone: 505-271-2633

Phone:

Fax: 505-332-3688

Fax:

Email: coffeemoon@thuntek.net

Email:

Ship via

o USPS Priority Mail .. or .. o USPS Regular Mail

Quantity

Unit 1

Description (Roast 2)

Grind 3

Prod. #

..Unit.. ..Price..

..$.. Amount..

e.g., 4

oz

Pai Mu Tan Tea ............ (N/A)

N/A

101

$17.75

$17.75

e.g., 5

lb

Jamaican Blue Mountain Coffee ............ (M)

W

6

$42.00

$210.00

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

1- Unit: lbs or oz ........................................................................................................... SUBTOTAL

.

2- If 5 lbs or over, Roast: C=Light, M=Medium; V=Vienna; E=Espresso; F=French; I=Italian ........ SALES TAX

.

3- Grind: W=Whole Bean; C=Coarse; DC=Drip Cone; DF=Drip Flat; E=Espresso; EF=Extra Fine ......... SHIPPING

.

4- PROD.#=Product Number from Website ............................................................... TOTAL DUE

.

Method of Payment

o US Check or Money Order, enclosed

Credit Card: ........................... o Master Card .......... o Visa

Name on Credit Card (Printed)

Signature

Credit Card #

Expires

THANK YOU FOR YOUR BUSINESS!

return to "How to Order"