Order Form


ORDERED BY: Name _______________________________________________________________________________ Street ________________________________________________Apartment/Suite # ________________ City ________________________________________________________________________________ State/Zip ____________________________________________________________________________ Daytime Phone _______________________________________________________________________ Evening Phone _______________________________________________________________________ Email _____________________________________________________________________________


please provide an email address if you would like to be sent upS tracking information or our latest promotions and item information.


SHIP TO: Name _______________________________________________________________________________ Street ________________________________________________Apartment/Suite # ________________ City ________________________________________________________________________________ State/Zip ____________________________________________________________________________


Ordering a Gift? ( IteM code )Yes ( )No If yes, please use Gift Order Section on reverse side. deScrIptIon Qty prIce total


PLEASE MAIL ORDERS TO: The Blueberry Store P.O. Box 195 Grand Junction, MI 49056


Method of Payment:


( ) **Check or Money Order Payable to: Te Blueberry Store ( ) MasterCard ( ) Amex


( ) Visa ( ) Discover Account Number


__________________________________ Expiration Date ______/_____/______ Signature:_________________________


o From time to time we may share information with our marketing partners. If you do not wish to be a part of this, please opt-out by checking the box above when ordering or simply call us toll free at 877-654-2400.


Toll Free 1-877-654-2400


The Blueberry Store Gift Orders


IteM total dIScount code? Enter Here Subtotal ShIppIng (See page 16)


* MIchIgan taX (MI reSIdentS only) total FroM bacKSIde grand total


* Michigan tax is applicable for non-food items only. ** Check payments may be subject to longer service times.


please enter your catalog code from Back Cover in the box.


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If you need more space for your orders, please turn the page or attach a separate piece of paper.


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