Order By Telephone (800) 345-5185

Burgers' Smokehouse 32819 Hwy 87 California, Missouri , 65018-9905

To order by Fax, dial (573)796-3137

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1. START HERE
Ordered by:

Name :	_______________________________________________________
Street :	_______________________________________________________
City :	____________________________ State :_______ Zip :___________

2.
Ship the following items to me at the above address to arrive:

Now	Christmas	Thanksgiving
For other date:_____________

Qty	Item No.	Price Ea.	Total
1.
2.
3.
4.
5.
Total

Total for all orders: $_______________

4. Method of payment:

	Payment enclosed		Discover (16 digits)		Diners Club (14 digits)
	MasterCard (16 digits)		Visa (13 or 16 digits)
	Charge to my Burgers' Preapproved Credit		American Express (15 digits)

Card Number
___	___	___	___	___	___	___	___	___	___	___	___	___	___	___	___
1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16
Expiration Date (must have expiration date)								______/______
Signature:______________________________________________________
May we have your daytime and evening phone number?
Daytime								Evening
(_____)_______-__________								(_____)______-__________

3. Gift Order No. 1
Ship to:

Name :	_______________________________________________________
Street :	_______________________________________________________
City :	____________________________ State :_______ Zip :___________

Ship gift No. 1 to arrive:

Now	Christmas	Thanksgiving
For other date:_______________________________________
Send with greetings from:_______________________________
No greetings necessary
Recipient's telephone number to help UPS make delivery:
(_____)______-__________

Qty	Item No.	Price Ea.	Total
1.
2.

Gift Order No. 2
Ship to:

Name :	_______________________________________________________
Street :	_______________________________________________________
City :	____________________________ State :_______ Zip :___________

Ship gift No. 2 to arrive:

Now	Christmas	Thanksgiving
For other date:_______________________________________
Send with greetings from:_______________________________
No greetings necessary
Recipient's telephone number to help UPS make delivery:
(_____)______-__________

Qty	Item No.	Price Ea.	Total
1.
2.

Gift Order No. 3
Ship to:

Name :	_______________________________________________________
Street :	_______________________________________________________
City :	____________________________ State :_______ Zip :___________

Ship gift No. 3 to arrive:

Now	Christmas	Thanksgiving
For other date:_______________________________________
Send with greetings from:_______________________________
No greetings necessary
Recipient's telephone number to help UPS make delivery:
(_____)______-__________

Qty	Item No.	Price Ea.	Total
1.
2.