Goldilocks Mail Order Form  - www.goldilocks.ca                                        
FAX# 604-736-7557   E-mail: order@goldilocks.ca
Sender Information

Last Name _______________________
First Name ____________________________
Street Address __________________________________________________________
City _________________________ Province:__________

  Zip:_________
Daytime Phone: (      ) ____ - _____ Evening Phone: (      )  ____ - _____
E-mail Address __________________________________
Recipient Information

Last Name _______________________
First Name ____________________________
Street Address __________________________________________________________
City _________________________ Province:___________   Zip:_________
Daytime Phone: (      ) ____ - _____ Evening Phone: (      ) ____ - _____
Items Ordered
Description Price # of Orders Total Cost
Ensaymada Regular $23.40 ___________

__________

Ensaymada Sampler $25.40 ___________ __________
Mamon Regular $32.40 ___________ __________
Mamon Sampler $33.60 ___________ __________
Traditional Favorites $55.80 ___________ __________
Goldilocks Sampler $61.60 ___________ __________
Polvoron Sampler $31.50 ___________ __________
Total Product Cost __________
Shipping Charge (see instructions) __________
Total Delivered Cost __________
Method of Payment:
___VISA             ___MASTERCARD ___AMEX
Cardholder's Name Account Number Exp. Date
_____________________________ ________________________ ____/____
Signature: __________________________________ Date Required: ______________
Office Use Only
Date & Time Received: __________ Shipping Date: ____________  
Received By: __________