Centreville Rotary March Fruit Sales Order Form
*
First Name
*
Last Name
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number
*
Email Address
Centreville Rotarians Name - if referred:
*
My Preferred pick up location is?
(Pick One)
Easton: 10 Sat, Mar 17th Hair of Dog Liquor Store
Centreville :4-6: Fri, Mar 16th & 9-2 Sat 17th Behind the Acme store
Kent Island: 4 Sat, Mar 17th at KI High
California Navel Oranges
10 lb Bag Navel Oranges - $12.00
20 lb Box Navel Oranges - $20.00
40 lb Box Navel Oranges - $35.00
Texas Ruby Red Grapefruit
10 lb Bag Ruby Grapefruit - $11.00
20 lb Box Ruby Grapefruit - $18.00
40 lb Box Ruby Grapefruit - $30.00
Maple Syrup
Pint Jar of Syrup - $10.00
Quart Jar of Syrup - $17.00
*
Indicates Response Required
Powered by
FormSite.com