Hedgeapple Mail Order or FAX Form

Mail Order AddressFax Number
Hedgeapple.com
1820 W 15th
Emporia, Ks
66801		(305) 574-0804
Mail or FAX completed form to the above.
Qty PricesShipping Total
4
 $8.00 $6.00 $14.00
8
 $14.00 $8.00 $22.00
12
$18.00 $10.00 $28.00
24
 $30.00 $12.00 $42.00
36
$36.00 $14.00 $50.00

Name: (Required)
Company Name:
(Optional)
E-Mail:
Street Address:
City, State, Zip: ,
Phone:
Hedgeapple
Package Desired:
(One Tray per Hedgeapple included)
Payment Type MasterCard Visa Discovery Check
Credit Card number,
four digits at a time.
Expiration Date (example 01/02) :
Comments:

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Mail or FAX above completed form.


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