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The Coffee Critic®

Fax/Mail Order Form

To print this page out, choose File/Print. Please complete this form and FAX it to 707-462-0431 or mail completed form with your check, money order or credit card number and expiration date. Please Note: we do not accept cash or COD orders. Be sure to include the appropriate shipping fees for each shipping address. Please mail your order to:

The Coffee Critic
Mail Order Customer Service
476 North State Street
Ukiah, California 95482

Your order may also be placed by phone
1-800-4CRITIC (1-800-427-4842).

For expedited shipments, please phone the above number.

ORDERED BY (Please print clearly)
If using a credit card this information must match the credit card billing information.


	Name______________________________________________


	Address____________________________________________


	City_______________________________________________


	State____________ Zip_______________________________


	Day Phone__________________________________________


	Evening Phone_______________________________________


	GIFT ADDRESS (if different from above)


	Name___________________________________________


	Address_________________________________________


	City_________________State_________ Zip___________


	Day Phone__________________________________________


	Evening Phone__________________________________________


	Gift Message


	________________________________________________


	Description


	Price


	Qty


	______________________________________________________


	______________________________________________________


	______________________________________________________


	______________________________________________________


	______________________________________________________


	______________________________________________________


	______________________________________________________


	Subtotal

	For Accessories & Gift Items shipped within California, please add 7.75% State Sales Tax

	Shipping & Handling

	Total


	_____________________

	_____________________

	_____________________

	_____________________


	For expedited shipping, please phone 1-800-4CRITIC (1-800-427-4842).


	PAYMENT INFORMATION

Mastercard_____VISA_____

Name on Card______________________________________

Billing Address of Card Holder__________________________

City____________________State_________ Zip___________

Credit Card Number__________________________________

Credit Card Expiration Date(month/year)____________________________

Prices Subject to Change

Wake Up And Smell The Coffee®

1-800-4CRITIC
(1-800-427-4842)

476 North State St. Ukiah CA.
(707) 462-6333

Racer's Blend, Mariah's Blend, S.F.K. and The Coffee Critic are registered trademarks of The Coffee Critic, Inc.
The Coffee Critic®, Inc. received permission to use the registered trademark for Wake Up and Smell The Coffee from Linda Nederman-Mountanos.
The Coffee Critic®), Inc. received permission to use the registered trademark for Lindsay's Teas from Mountanos Brothers Coffee Company.