Burner Cover King Order Form

Please fill out this form and Submit
for questions please call (904) 266-2473

Sold To:
Name:	Day Time Phone:( )
Street Address:
City: State: Zip:

Ship To:
Name:	Day Time Phone:( )
Street Address:
City: State Zip

Order:
	Quantity	Name of Item	Price Each	Total Price	Ship/Hand	Total
1
2
3
4
5
6

Shipping Insurance (OPTIONAL) Add $1.35
+ Florida Sales Tax (Florida residence only) 7%
Total Order

Payment Method

Please Circle One: Master Card Visa Discover Payment Enclosed

Please make check or money order payable to:
Kitchen King Wholesale Distributors
(U.S. Funds Only, DO NOT SEND CASH)

Master Card, Visa or Discover Number:

Expiration Date: Signature:

Credit Card Fraud is a crime and will be prosecuted to the fullest extent of the law

If you would like e-mail confirmation of shipment of your order, please provide e-mail address

(You will be able to print your order, after it is submitted.)
Thank You for Your Order!

You can also email or snail mail this competed form to:
E-mail: burnercovers@yahoo.com
Burner Cover King
615 Martin Luther King, Jr. Dr.
Baldwin, Fl., 32234
Phone/Fax: (904) 266-2473

Maintained by: Stacy Cannady www.stacycannady.com