The Piper's Peck
P.O. Box 433, Bellefonte, Pa 16823 USA
www.piperspeck.com
814.355.0215
Name (please print)
 
Address
 
City
 
state
 
zip
 
Daytime Phone
(_____)

payment method (check method)

Cash O
 Check O Money Order O

If you would like us to ship to a different address, please fill out the "Shipping Address" box below.
Follow the sample below and complete all ordering information
Item name
Size
price each
x
qnty
=
total price
Cayenne Pepper Jelly
9oz
$6.50
x
2
=
     
x
   =  
     
x
   =  
     
x
   =  
     
x
   =  
     
x
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x
   =  
     
x
   =  
     
x
   =  
     
x
   =  
Merchandise total
 $

Shipping and handling (from shipping calculator)

 $
Total Enclosed
 $

 

 

Shipping Address (if different from above)
Name (please print)
 
Address
 
City
 
state
 
zip
 
country
 
Daytime Phone
(_____)