Kroger 2020-2021

Order Form (Please make additional copies for future use.)

1. SHIP TO

Store #

800-241-2094 Fax 800-880-9759 Local Fax 706-546-8482 Mail to:

2. ORDERED BY Customer # Address City State ZIP Code™ Phone Name of Business Address City State ZIP Code™

burton + BURTON ® 325 Cleveland Road Bogart, GA 30622

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 3. ORDER

Description

Product Number

Quantity

Unit Price

Total

May we substitute with similar product if out of any item? ❑ Yes ❑ No ❑ Call if out Discounts, if any, will be calculated and applied to your order. Shipping and handling charges will be added to your order. Your order will be shipped within 24 hours of receipt of order (not including Saturday, Sunday, or holidays). For additional items, please use another copy of this page. Prices subject to change without notice. Orders subject to acceptance in Bogart, Georgia. Customer consents to the jurisdiction of any court in the State of Georgia and the laws of Georgia. Total number of pages being transmitted including this sheet