******ORDER FORM******

For your convenience, we offer this order form. Please print it, fill in your order information, and either fax or mail it to us. We do not recommend e-mailing credit card information. You are also welcome to call us using our toll-free number.

Today's Date _______
Requested Date to Receive ___________

1186 Williston Rd, South Burlington VT 05403
Tel: 802-863-0143 Fax:802-863-1928
Toll-Free: 1-800-540-4261
Email: cheesetraders@gmail.com
Web: www.cheesetraders.com

Purchaser's Name ____________________________ Day Telephone _________
Street Address ______________________________ Eve Telephone _________
City/State/Zip ______________________________ Email ______________
Purchaser's Credit Card Information
Visacard or Mastercard # ________________ Expiration Date ___________
Name as it appears on Card ________________________________________
Ship To Name ____________________________________________
Ship To Street Address _____________________________________
Ship To City/State/Zip ______________________________________
Ship To Telephone __________________________
Include a Gift Card? no ___ yes, with this message _______________________________________________

Product Ordered Price Each Quantity Total Price
____________________________ _________ ______ $____________
____________________________ _________ ______ $____________
____________________________ _________ ______ $____________
____________________________ _________ ______ $____________
____________________________ _________ ______ $____________
Product Total $____________
Pack & Ship Fees $____________
Order Total $____________