Distributor: Lynne Herf FRR#R534
Name:_________________________________________________
Address:_______________________________________________
City:__________________________________________________
State:_________
Zip:__________ Date:______________________
Phone:(_______)
________________________________________
Payment by: Check____ Visa____
M/C____ Amex___
Card#: _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _
Expires:______________
Cardholder
signature:_____________________________________
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| Code | Product | Retail Price |
Tax | Total Price* |
How Many Bags? |
Extended Totals |
|---|---|---|---|---|---|---|
| DOG40 | 40 Lbs. Kibble Dog Food | $45.95 | $3.45 | $49.40 | ________ | $_______ |
| DOG20 | 20 Lbs. Kibble Dog Food | $24.95 | $1.87 | $26.82 | ________ | $_______ |
| DOG10 | 10 Lbs. Kibble Dog Food | $14.95 | $1.12 | $16.07 | ________ | $_______ |
| DOG6 | 6 Lbs. Kibble Dog Food | $12.45 | $.93 | $13.38 | ________ | $_______ |
| NUG40 | 40 Lbs. Nugget Dog Food | $45.95 | $3.45 | $49.40 | ________ | $_______ |
| NUG20 | 20 Lbs. Nugget Dog Food | $24.95 | $1.87 | $26.82 | ________ | $_______ |
| SEN40 | 40 Lbs. Senior Dog Food | $45.95 | $3.45 | $49.40 | ________ | $_______ |
| SEN20 | 20 Lbs. Senior Dog Food | $24.95 | $1.87 | $26.82 | ________ | $_______ |
| SEN10 | 10 Lbs. Senior Dog Food | $14.95 | $1.12 | $16.07 | ________ | $_______ |
| PLUS40 | 40 Lbs. Senior PLUS Dog Food | $49.95 | $3.75 | $53.70 | ________ | $_______ |
| PLUS20 | 20 Lbs. Senior PLUS Dog Food | $26.95 | $2.02 | $28.97 | ________ | $_______ |
| PLUS10 | 10 Lbs. Senior PLUS Dog Food | $15.95 | $1.20 | $17.15 | ________ | $_______ |
| LMR40 | 40 Lbs. Lamb/Millet/Rice Dog Food | $49.95 | $3.75 | $53.70 | ________ | $_______ |
| LMR20 | 20 Lbs. Lamb/Millet/Rice Dog Food | $26.95 | $2.02 | $28.97 | ________ | $_______ |
| LMR10 | 10 Lbs. Lamb/Millet/Rice Dog Food | $15.95 | $1.20 | $17.15 | ________ | $_______ |
| BON20 | 20 Lbs. Dog Bone Treat | $34.95 | $2.62 | $37.57 | ________ | $_______ |
| BON10 | 10 Lbs. Dog Bone Treat | $19.95 | $1.56 | $21.45 | ________ | $_______ |
| BON4 | 4 Lbs. Dog Bone Treat | $10.50 | $.79 | $11.29 | ________ | $_______ |
| PNUT20 | 20 Lbs. Peanut Dog Bone Treat | $34.95 | $2.62 | $37.57 | ________ | $_______ |
| PNUT4 | 4 Lbs. Peanut Dog Bone Treat | $10.91 | $0.82 | $11.73 | ________ | $_______ |
| LAMB20 | 20 Lbs. Lamb Dog Bone Treat | $36.92 | $2.77 | $39.69 | ________ | $_______ |
| LAMB4 | 4 Lbs. Lamb Dog Bone Treat | $11.93 | $0.89 | $12.82 | ________ | $_______ |
| JW | 4 Lbs. Jubilee Wafers | $13.50 | $1.02 | $14.52 | ________ | $_______ |
| JW20 | 20 Lbs. Jubilee Wafers | $39.95 | $3.00 | $42.95 | ________ | $_______ |
| DW48 | 48 oz Dry Water Ultra Fresh Dog Food | $13.50 | $1.02 | $14.52 | ________ | $_______ |
| CAT40 | 40 Lbs. Premium Cat Food | $73.50 | $5.51 | $79.01 | ________ | $_______ |
| CAT20 | 20 Lbs. Premium Cat Food | $37.50 | $2.81 | $40.30 | ________ | $_______ |
| CAT9 | 9 Lbs. Premium Cat Food | $18.98 | $1.42 | $20.37 | ________ | $_______ |
| CAT6 | 6 Lbs. Premium Cat Food | $15.95 | $1.20 | $17.15 | ________ | $_______ |
| CH40 | 40 Lbs. Cat Hairball Food | $73.50 | $5.51 | $79.01 | ________ | $_______ |
| CH20 | 20 Lbs. Cat Hairball Food | $37.50 | $2.81 | $40.30 | ________ | $_______ |
| CH6 | 6 Lbs. Cat Hairball Food | $15.95 | $1.20 | $17.15 | ________ | $_______ |
| LIT9 | 9 Lbs. Adult LITE Cat Food | $18.95 | $1.42 | $20.37 | ________ | $_______ |
| CT12 | 12 oz Cat /Kitten Treat | $4.25 | $.32 | $4.57 | ________ | $_______ |
| TOTAL ORDER AMOUNT = | $_______ | |||||
AUTHORIZATION FOR AUTOMATIC SHIPMENT:
I hereby authorize FLINT
RIVER RANCH to automatically deliver or ship prepaid, the following product
order and request FLINT RIVER RANCH initiate debit entries to my credit card to
effect any payment owing me to FLINT RIVER RANCH . I may cancel this
authorization upon written notice to FLINT RIVER RANCH.
CODE_______ AMOUNT_______ SHIP EVERY: 3 Weeks__ Month__
Other_________
CODE_______ AMOUNT_______ SHIP EVERY: 3 Weeks__ Month__
Other_________
Date: _____________ Cardholder Signature:____________________________________
ESTIMATED DELIVERY TIME: (does not include time to receive mail, weekend or
holidays.)
West Coast: 3-5 business days. . . Central: 5-8 business days. . .
East/Southeast: 7-10 business days.
Lynne Herf:
517-545-7149 FAX: 909-682-5057