FAX Order-Form for Ordering Fresh Lobsters,
Clambakes, and Other Seafood from Champlin's
Print this FAX-form, fill it in, and FAX it to (401) 789-3580.
Important: Please review sections on "Ordering Information" and "Shipping Information" as these sections will provide information to assist you in filling out the FAX-Form. Filling out the FAX-Form is relatively easy. If you have any questions while filling it out please call us at (401) 783-3152 and ask for Bob Mitchell; or E-Mail us at info@champlins.com.
Date-to-Ship (for example, Tuesday June 5th): _____________________________________________
Date-to-Deliver (for example, Wednesday June 6th):
_____________________________________________
List items you wish to order:
Item 1:
_____________________________________________________
Quantity _____ $___________
Item 2:
_____________________________________________________
Quantity _____ $___________
Item 3:
_____________________________________________________
Quantity _____ $___________
Item 4:
_____________________________________________________
Quantity _____ $___________
SHIPPING ADDRESS: (location of where purchaser wishes order to be delivered)
Name of Individual Receiving Order :____________________________________
Person's Phone #:______________ Person's Additional Phone #: ______________
E-Mail Address: _______________
Address:__________________________________
Address/Apt:_______________________________
City:_______________________State:________Zip:_____________
Short message to receiver:___________________________________
BILLING ADDRESS:
Name of Individual on Credit Card:____________________________________
E-Mail Address:____________________________________
Billing Phone #:_______________ Additional Billing Phone #: _____________
Address:__________________________________
Address/Apt:_______________________________
City:_______________________State:________Zip:___________
CreditCard (check one): Visa___ MasterCard____
Credit Card Number:________________________________ Expiration Date:__________
Ship products_____ , or send Gift Certificate____
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