Vermont Peanut Butter Company Fax Form

Credit Card Fax Form

print, scan, fax, or email

fax: 1.802.735.1023
orders@vtpeanutbutter.com
phone: 1.877.846.6887

BILLING INFORMATION (PLEASE PRINT CLEARLY)

Name on Credit Card:

Full Address:

Phone:

Credit Card Type:

Credit Card Number:

Expiration Date:

3 digit security code on back of card:

PRODUCT INFORMATION
QTY	PRICE	PEANUT BUTTER
	$5.95	Creamy
	$5.95	Chunky
	$7.95	Banana Nut Crunch (banana and nuts)
	$7.95	Avalanche (white chocolate)
	$7.95	Maple Walnut (vermont maple syrup & walnuts)
	$7.95	Good Karma (dark chocolate)
	$7.95	Stowe (cinnamon raisin)
	$7.95	BEE Nut Butter (vermont honey)
	$9.25	Green Mountain Goodness (almond blend w/flax & pumpkin seeds)
	$9.25	Mad River Mojo (almond blend w/ cranberries,flax,pumpkin seeds, honey)
	$9.25	Champlain Cherry (almond butter w/ dark chocolate & cherries)
	$9.25	Almond Butter
SHIPPING INFOMRATION 1 - 2 Jars $9.95, 3 - 6 Jars $10.95 GREAT DEAL !, 7 - 8 Jars $13.95 BETTER DEAL !, 9 Jars FREE - BEST DEAL !, 10 Jars + (Will constitute a new order. First 9 will still be free.)
QTY		VTPB GEAR
	Contact Us for Price	Mountain Bike / Cycling Jersey (circle one.....unisex L, XL)
		Mens Hooded Sweatshirt (circle) Brown...M, L, XL - Black...M, L, XL
		Ladies Hooded Sweatshirt (circle) Light Blue...S, M - Black...M, L, XL
		Kids Hooded Sweatshirt (circle) Navy...M, L, XL - Pink...M, L
		Adult Tees (circle) Brown...M, L, XL

This is a dedicated FAX line to Vermont Peanut Butter Company and is 100% secure. All Credit Card numbers are shredded once used for this order and all FAXED orders are placed into a secure file for our records use only.