Order By Telephone
(800) 345-5185
Burgers' Smokehouse
32819 Hwy 87
California, Missouri , 65018-9905
To order by Fax,
dial (573)796-3137

Print this order form using your browser's "Print" command.

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:_____________

QtyItem 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?
DaytimeEvening
(_____)_______-__________(_____)______-__________





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:
(_____)______-__________

QtyItem 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:
(_____)______-__________

QtyItem 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:
(_____)______-__________

QtyItem No.Price Ea.Total
1.


2.