ORDERED BY: Name _______________________________________________________________________ Street ________________________________________________Apartment/Suite # ________ City ___________________________________ State ___________Zip __________________ Daytime Phone __________________________Evening Phone ________________________ Email _______________________________________________________________________


ORDER FORM 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? ( )Yes ( )No If yes, please use Gift Order Section on reverse side.


Requested ship arrival date ___/___/____ ITEM CODE


*We will do our best to get the order delivered around specifi ed time where possible


DESCRIPTION QTY PRICE TOTAL


ITEM 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: T e Blueberry Store ( ) MasterCard ( ) Amex


( ) Visa ( ) Discover Account Number


__________________________________ CVS Code (3 or 4 digits) ______________


Expiration Date ______/_____/______ Signature:_________________________


DISCOUNT CODE? Enter Here SUBTOTAL SHIPPING (SEE PAGE 18)


* 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 the yellow box on the back cover


❏ 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.


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