Brockway Inn / Boreal Beans - Order form

Print this form, fill it out and mail it in with your payment.

Name
 
Address (No PO Boxes)  
City, State, Zip  
Phone #  

Quantity

Size

Description / Color

Total

       
       
       
       
       
    Sub-total  
  Michigan residents add 6% sales tax  
  Grand Total  


Shipping / Handling is built into the item price

Payment may be made by check, money order or cashiers check.
Please make payable to Brockway Inn.

You may also pay by credit card:
Credit Card Information (Visa or Mastercard accepted)

Name on card____________________________________________

Card_____________________________________exp. date_______

I agree to allow Brockway Inn to charge my credit card for this order


_________________________________________________________

signature of cardholder

Brockway Inn
PO Box 92
Copper Harbor, MI 49918
(906) 289-4588

Thank you very much for your order!!