This is the Ready to Eat FRESH CHILES Order Form. *print out this form and fax or mail it in.*
Fresh Chiles are sold in half-pint quantities. This is a great way to taste test different varieties.
The fresh chiles are $4.50 per half-pint, plus shipping. 6 half-pints fit in one box.
Minimum order is one (1) box.  Please order in full box quantities (6 half-pints, 12, 18, 24etc)  
**While we will try to ship when you request, orders may be delayed until all varieties are available.
For additional information about ordering Click Here.  
PLEASE PRINT CLEARLY!!!  and THANK YOU FOR YOUR ORDER.

2008

US Mail Address (=Credit Card Billing Address)

UPS Shipping Address 
(except AK, HI, PR - ship via US Mail)

Name

 

 

Business?

 

 

Address

 

 

City,State,Zip

 

 

Phone 

We Must have for shipping!

Day#

Night#

Email

 

 Please write very clearly!

Requested Delivery Week

Sept 8 - Sept 15 - Sept 22
Sept 29 - Oct 6

Please read our SUBSTITUTE policy, and how we handle unavailable chiles.

Substitutes

1.

2.

3.

4.

5.

6.

Name

QTY

Name

QTY

SHIPPING CHARGES- are based on your region: East, Central, West, or Far. See MAP.

1.

 

11.

 

Minimum Order is six half-pints (one box).

2.

 

12.

 

 

 

West & Far

Central

East

3.

 

13.

 

Qty

Fresh

S/H

Total

S/H

Total

S/H

Total

4.

 

14.

 

6

$27

$13

$40

$11

$38

$9

$36

5.

 

15.

 

12

$54

$17

$71

$15

$69

$13

$67

6.

 

16.

 

18

$81

$21

$102

$19

$100

$17

$98

7.

 

17.

 

24

$108

$25

$133

$23

$131

$21

$129

8.

 

18.

 

30

$135

$29

$164

$27

$162

$25

$160

9.

 

19.

 

36

$162

$33

$195

$31

$193

$29

$191

10.

 

20.

 

Each add’l box

$5

 

$5

 

$5

Terms: Check, MO, MasterCard, Visa, Discover, AmEx

FRESH TOTAL QTY _____ x $4.50 each

$

Name on Card:

Books and Supplies Total

$

Card Number:

(NJ residents only) 7% Sales Tax

$

Exp.Date:

CID/V-Code:

(see chart above) Shipping Charges

$

CID=AmEx - on front of card, 4 digits above & right of #; 
Visa, MasterCard, Discover - on back of card, last 3 digits in strip where you sign your name

              
GRAND TOTAL

$

Signature:

Thank You for your order!

Please make Money Orders or Checks payable to:     
Cross Country Nurseries,  PO Box 170,  Rosemont, New Jersey   08556-0170 
Phone (908) 996-4646    Fax (908) 996-4638