Print this page, complete the form, and mail or fax to Name______________________________________________________ Address____________________________________________________ City___________________________ State________ Zip____________ Phone____________________________Email_____________________ Credit Card Number__________________________________________ Expiration Date_____________________ Circle one - MC Visa Signature___________________________________________________ Paid by PayPal from this account_______________________________ SHIPPER___________________________________________________
Nutty Girl, Inc., 233 Jaybird Road, Carrollton, GA 30117
fax 770-214-2953
Personal check will delay shipment, prefer money order
if you cannot use Paypal or a credit card.
| QTY | Description | Price | Subtotal | ||
| Single Six Ounce Box | 9.50 each | ||||
| Single Twelve Ounce Box | 18.50 each | ||||
| Gift Set (2 Six oz and 1 Twelve oz Boxes) | 37.50 each | ||||
| Case of 16 Six Ounce Boxes | 152.00 case | ||||
| Case of 8 Twelve Ounce Boxes | 148.00 case | ||||
| 5 pound Bulk Bag | 95.00 bag | ||||
| Georgia Residents add 7% Sales Tax | |||||
| Shipping - See this CHART. | |||||
![]() |
TOTAL AMOUNT REMITTED | ||||