Make $$ Payable to: Denis Kitchen Publishing Co., LLC - P. O. Box 2250, Amherst, Massachusetts 01004 Mail to the attention of STACEY KITCHEN . . . . . . . . . . . . . . . . . . . . Phone (413) 259-1627 - Fax (413) 259-1812
Your Billing / Mailing Address:
Name:
Street:
City, State, Zip Code:
Country:
Phone number:			Fax number(optional):
Your e-mail address (optional):
Shipping Address (If different from Mailing Address):
Name:
Street:
City, State, Zip:
Items Ordered:
Item Number:	Item Description:		Quantity:	Item Price:	Total Price:
Subtotal:
Sales Tax (Massachusetts only), 5%:
(We can total this and fax it back to you if necessary* * )Shipping Charge:
(leave blank unless you know the shipping charge * * )Total:
Payment Options: Visa, MasterCard, Check/Money Order, Cash (at own risk-sent registered?)
Credit Card Customers please give the following info:
Type of Card:	Card Number		Expiration Date:	Name as it appears on the card:
Visa or MasterCard
Card Code (the last 3 digits on the BACK of the card that are NOT on the front): __________