Ben & Jerry's Printable Order Form

Cone Delivery Form

Contact Name_________________________

Phone______________Email_____________

Company Name________________________

Delivery Address______________

Delivery Time (circle one) 1-5 PM or 5-7 PM

or Special Circumstance_________

How many of each would you like?

__Chocolate Chip Cookie Dough

__Chocolate Fudge Brownie Yogurt

__No Sugar Vanilla Fudge Chip

__Coffee Coffee BuzzBuzzBuzz

__Triple Caramel Chunk

__Berry Berry Extraordinary Sorbet

Total # Scoops____ Total Donation $_____

(Minimum $5 suggested donation per scoop)

Mail, Fax or Email to:

139 S. Sherman, Spokane, WA 99202

744-3411ph 744-3114fx

tracyt@wishingstar.org

Thank you for supporting Wishing Star Foundation