Kroger AirFill

Kroger Order Form (Please make additional copies for future use.) USE BLUE OR BLACK INK WHEN COMPLETING THIS FORM.

Item # Qty

Description

Pieces

Del.

Order

Included Cost

4904636 4656936 4870036 463536 463326 4737536 404036 4976836 4905736 4756336 4759836 7859326 7859326G 7859426 7859426G 7859526 7859526G 7859626 7859626G 7859726 7859726G 7859826 7859826G 7859926 7859926G 7860026 7860026G 7860126 7860126G 7860226 7860226G

CHA 36" *PKG* SPIDER-MAN

1 1 1 1 1 1 1 1 1 1 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

10.11 10.11 10.11 10.11 10.11 10.11 10.11 10.11 10.11 10.11 10.11

CHA 44" *PKG* BATMAN AIRWALKER CHA 41" *PKG* CARS 3 AIRWALKER CHA 35" *PKG* MINNIE MOUSE CHA 29" *PKG* MICKEY MOUSE CHA 57" *PKG* FROZEN ELSA SNOW CHA 58" *PKG* FROZEN 2 AIRWALKER CHA 55" *PKG* PRINCESS AIRWALKER ANI 46" *PKG* MAGICAL UNICORN CHA 38" *PKG* R2D2 AIRWALKER CHA 54" *PKG* PAW PATROL CHASE NUM 25" *PKG* STANDUPS 0 SILVER NUM 25" *PKG* STANDUPS 0 GOLD NUM 25" *PKG* STANDUPS 1 SILVER NUM 25" *PKG* STANDUPS 1 GOLD NUM 25" *PKG* STANDUPS 2 SILVER NUM 25" *PKG* STANDUPS 2 GOLD NUM 25" *PKG* STANDUPS 3 SILVER NUM 25" *PKG* STANDUPS 3 GOLD NUM 25" *PKG* STANDUPS 4 SILVER NUM 25" *PKG* STANDUPS 4 GOLD NUM 25" *PKG* STANDUPS 5 SILVER NUM 25" *PKG* STANDUPS 5 GOLD NUM 25" *PKG* STANDUPS 6 SILVER NUM 25" *PKG* STANDUPS 6 GOLD NUM 25" *PKG* STANDUPS 7 SILVER NUM 25" *PKG* STANDUPS 7 GOLD NUM 25" *PKG* STANDUPS 8 SILVER NUM 25" *PKG* STANDUPS 8 GOLD NUM 25" *PKG* STANDUPS 9 SILVER NUM 25" *PKG* STANDUPS 9 GOLD WEIGHT SILVER FOIL COVERED INF QUALATEX HAND INFLATOR

4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 8.52 4.85

14778 HI795

12

1

Fax 800-880-9759

Store # _____________________________________

Phone ______________________________________

Name ______________________________________

City, State __________________________________

ZIP_________________________________________

2