Information required for purchase of green Kona Coffee:
Please print, fill out, then fax this form to 1 808 322-4008
Thanks for your order.

Desired products: ______________________________________________________

Name of principal: _____________________________________________________

Name of business: _____________________________________________________

Address: ____________________________________________________________

___________________________________________________________________

___________________________________________________________________

Phone number: _______________________________________________________

Credit card number: ___________________________________________________

Credit card expiry date: ________________________________________________

Credit card number: ___________________________________________________

Method of shipping desired: _____________________________________________

__________________________________________________________________

Date of shipping desired: _______________________________________________

Signature for personal guarantee of payment: ________________________________

Please print, fill out, then fax this form to 1 808 322-4008
Thanks for your order.