Cottage Coffee Company - Victoria, BC, Canada

- Taxes not applicable
- Order processed on this form can be picked up and paid for at one of two locatations - see below.
- This form is for local orders only (Victoria, BC). For out of town order please contact us
- Free Home Delivery in Victoria if three or more lbs. are ordered at one time.

Field names in RED are required.

First Name:

Last Name:

Phone Number:
( )

Email Address:

Address:

Club / Association:

Pickup Location:

	Frank Whites Dive Store 1620 Blanshard St (250) 385-4713
	Avalon Cottage Winery 643 David St. (250) 386-4030

Your Order: Note: The following are all 1 lb bags.
Coffee Name	Price	Qty.
Brazil Santos	$15.00
Costa Rican Terrasu	$15.00
Colombian Supremo	$15.50
Espresso	$15.50
French Roast	$15.50
Fog Cutter	$15.50
Breakfast Blend Decaf	$15.50

Sumatra Mandheling	$17.50
Kenya AA	$17.50

Comments :

Please enter the characters that you see below in the box to the left:
Code

(If you have trouble reading the above characters please click on the characters to
get a new set of characters or click on the speaker icon to have them read aloud.)

Great Coffee - Better World