Cauliflower Publishing CompanyOrder
This is a simple two page printable
form for ordering via fax, regular mail, email, or for requesting
a catalog. To order via fax or regular mail: 1) Select options
in ALL pulldown menus BEFORE printing form, 2) type in text blocks
(or print form and fill in by hand)
To order via email, hit "submit"
after typing in all information. Otherwise, print and fax; or
print and mail.
Select Form Submission Option Here
Print & FAX: 360.332.9871
Print & MAIL: 8437 Catalina Ct., Blaine, WA 98230
Phone the order: 360.332.9835
Email to order to: email@example.com
Request a Catalog at:firstname.lastname@example.org
Street Address: Apt.
City: State: Zip
Would you like:our product catalog? notification
of new products?
To place an order, fill in purchasing
Select Payment Method
Enclosed Money Order
Name on Credit Card:
Please enter product information
on Page 2, below:
Order FormPage 2
Type product information, or print
form and enter information by hand:
Calculate totals with your own calculator.
Type or hand write totals below.
Sum of Subtotals:
Add Shipping @ .08%:
WA Residents Add .078% Sales Tax: