Jack London's Bar & Grill in Carmel by the Sea

Fax Order Form FAX NO: (831) 626-0941

Please check the item(s) you want to order.

Check	Item	Size	Price	How many?	Total
	T-Shirts	M / L / XL	$20.00		$
	Sweat Shirts	M / L / XL	$30.00		$
	Server Apron (w/Pockets)	One Size	$22.00		$
	Cook's Apron	One Size	$15.00		$
	Pint Glass	---	$3.00		$
Shipping Charge					$6.00
7.25% tax required for item(s) shipped to California address.					$
Total					$

Customer Information

Name:

Address:

State/Zip:

Phone No.:

Fax No.:

Email Address (Optional):

Payment Information

I will send a check with this form.

Please charge to my credit card.

Card Name: VISAMASTERAMEX

Card Holder Name:

Expiration Date:

Signature:

Shipping Address

Same as Cusomer Info.

Different from Customer Info.

Name:

Address:

State/Zip:

Phone No.:

Fax No.:

Email Address (Optional):

THANK YOU FOR YOUR ORDER!