Please complete the following so your order may be processed correctly and promptly. Occasionally substitutions of item(s) or brand(s) may be necessary.

          Ordered by (billing address):
        Name: 	

Company: (optional) 

    	   Address: 

        E-mail address: 

Telephone: (day time) 

           (evenings) 

    Basket category name
            & number: 
              Price: $

Desired changes or substitutions:
                           

Shipping charges will be added to gift price.

                       Ship basket to:
   Recipient's name: 

Company: (optional) 

              Address: 

            Telephone: 

Message on enclosure card:
                     
Recipient's sex and age (or, if for family, how many members, ages, sexes):
                     

Recipient's kitchen color scheme (if known):
                     

     Coffee drinker? Yes No
              Decaf? Yes No
        Tea drinker? Yes No
              Decaf? Yes No

Special diet considerations:
                     

Recipient's hobbies or special interests:
                     

How did you find our web site (please include which 
search engine if used)?