The Original Jelly Bean Factory

Quantity Weight Description Price Extention
1 Blueberry Salt Water Taffy $5.00 $5.00
Product Total. $5.00

Shipping $14.00
Total $19.00

Bill To:

Ship To:


Company:
Name:
Address1:
Address2:
City:
State:
Zip:
Country:	NO International
Phone:
Fax:
E-Mail:

Shipping Info same as Billing
Company:
Name:
Address1:
Address2:
City:
State:
Zip:
Country:	NO International
Phone:
Fax:
E-Mail:

-------- Billing: ---------
Payment Method:
Credit Card Number:
Expiration Date: Month Year:

Verification #:
For your safety and security, We require that you enter your card's verification number.
VISA, Master Card and Discover,
The verification number is a 3-digit number printed on the back of your card.
It appears after and to the right of your card number.
American Express,
The verification number is a 4-digit number printed on the front of your card.
It appears after and to the right of your card number.

California Law prohibits the return of Food items. All Sales Final

Quantity	Weight	Description	Price	Extention
1		Blueberry Salt Water Taffy	$5.00	$5.00
		Product Total.		$5.00
		Shipping		$14.00
		Total		$19.00


Payment Method:
Credit Card Number:
Expiration Date:	Month	Year:
Verification #: