ORDER SIZES AND FLAVORS BY NUMBER               POPCORN-N-MORE • FAX: 315-782-3721
Quantity Size # Design Flavor(s) # $ Each $ Total
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Payment method:
____VISA  ___ MASTERCARD __ CHECK  __ AM-EX
CARD # ________________________
EXPIRATION DATE:_____________
SIGNATURE: ______________________________		 Subtotal .
Shipping & Handling .
7.75% NYS Tax .
Total .
ORDERED BY:

NAME: ______________________
ADDRESS: __________________________________
                       __________________________________

CITY: _______________________________________
STATE: _______________ ZIP: _________________
PHONE: ___________________________

SHIP TO:

NAME:________________________
ADDRESS: __________________________________
____________________________________________
CITY: ______________________________________
STATE:________________ZIP:__________________


GIFT MESSAGE:  _________________________________________
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Call us at 315-782-3721

118 Court Street • Watertown, NEW YORK 13601

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