K
lappenbach
BAKERY Gift Box Order Form
Fax to (870) 352-5348 or Mail to 108 West Fourth Street, Fordyce, Arkansas 71742
Please use new form for each ship to address
Gift Box Type*
c
Large Cardboard Box - $54
(choice of 5 breads or 2 breads and one cake)
c
Small Cardboard Box - $38
(choice of 3 breads or 1 cake)
c
Small Wooden Box - $55
(choice of 3 breads or 1 cake)
Breads
Cakes
c
Cinnamon
c
Cinnamon Raisin
c
Cinnamon Date
c
Fruit Nut
c
Rye
c
Jalapeno
c
Pumpernickel
c
Cracked Wheat
c
English Muffin
c
Sour Dough
c
Old Fashioned Pound Cake
c
Raspberry Swirl Old Fashioned Pound Cake
c
Chocolate Raspberry Cream Cake
c
Chocolate Nut Cake
c
Pineapple Pound Cake with Coconut Glaze
c
Lemon Poppyseed Pound Cake with Lemon
Glaze
Ship to Address
Name
___________________________________
Street
___________________________________
___________________________________
City,State,Zip
___________________________________
Gift Card Message
___________________________________
___________________________________
___________________________________
Ship Date:___________________________
Method of Payment
c
Visa
c
MasterCard
Card #: _____________________________
Expiration Date: ______________________
Billing Address
(for above card)
Name
___________________________________
Street
___________________________________
___________________________________
City,State,Zip
___________________________________
Phone Number:_______________________
Email:______________________________
*
Arkansas residents add 8.5% sales tax.
