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Automatic Shipment of coffee with a discount!


You Pick the Coffee, We ship it to you!


Requirements:


* Minimum 3 months participation to receive discounts of 15-20%


* Minimum 2 pounds per order (1/2 lb bags available)


* Orders processed on the 15th of each month


* Order 2 lbs and over receive 10% discount on coffee


* Orders 5 lbs and over receive 15% discount on coffee.


* Orders 25 lbs and over receive 20% discount on coffee.


* Download the form and then either email it to us at info@strpatch.com, mail it to P.O. Box 1187 Salado TX 76571, or just bring it into the store. We'll take it from there.


homephoto (40K)


SIGN UP ONLINE



CONTACT INFORMATION:


First and Last Name:

Name of Business:

E-mail:

Phone Number:

Extension:

SELECT THE COFFEE YOU WANT:

Would you like us to choose coffee for you? write Yes or No:

You Pick the Coffee - If you want to select your own coffee, tell us what you would like us to send you by month in the spaces listed below. We have over 100 coffees to choose from, so you might want to go look and write them down before filling out the blocks below. If you only want coffee delivered for a certain amount of time, place "NONE" in the months that you do not wish to place an order.

JANUARY SHIPMENT


FEBRUARY SHIPMENT


MARCH SHIPMENT


APRIL SHIPMENT


MAY SHIPMENT


JUNE SHIPMENT


JULY SHIPMENT


AUGUST SHIPMENT


SEPTEMBER SHIPMENT


OCTOBER SHIPMENT


NOVEMBER SHIPMENT


DECEMBER SHIPMENT


Choose Ground Coffee or Whole Bean

Would you like us to grind your coffee for you? Choose either Whole Bean, Ground Coarse (Peculator, K-Cup, or Press), Ground Medium (Drip), Ground Fine (Drip) or Ground Fine (Espresso) in the space provided:


SHIPPING ADDRESS:
ADDREESS:


ADDREESS:


City: State: Zip Code:

BILLING ADDRESS:
ADDREESS:


ADDREESS:


City: State: Zip Code:

PAYMENT INFORMATION:
Payment Type: (Visa, MC, DISC)

Card Number:

Expiration Date: Verification Code:



Comments, Questions, or Additional Instructions:


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