Evergreen Brewing Supply Order Form

In order to use this order form, your browser will be required to interpret "JavaScript". Microsoft Internet Explorer version 3.0 or better, and Netscape Navigator version 2.0 or better are "JavaScript" capable. If you are using America On-line and running Windows95, you need to upgrade your browser to the new 3.0 version for Windows95. If you are running Windows 3.X, then you must download Netscape Navigator from AOL at keyword NETSCAPE and use this browser to view this site after connecting to America On-line.
Fill in the Ship To: information, select product(s) from the drop-down lists, then type in a quantity and click another field, or press Tab.

If you would like to order more than one product from each category, select a product in each category that you wish to order, then click on "Submit Selected Products And Continue Order" button at bottom of page. The products you selected will be sent to Evergreen Brewing Supply via e-mail and the selection list cleared to allow further product selections. Values will appear in the row for "Previous Products Submitted" as a summary of all previous orders submitted in this manner.

When you have selected your final set of products, click on the button "Submit Final Order" and your final order will be sent to Evergreen Brewing Supply via e-mail and shipped within 24 hours of receipt of payment via United Parcel Service ground mail. International orders shipped via United States Postal Service.

Payment may be made by credit card using this form, or you may call us, or send a fax with your credit card company, credit card number, name on card, and card expiration date. Your credit card number sent via this form may be encoded for maximum protection by clicking on the "Encode" button after entering the credit card number.

Category
Product
Qty
Unit Price
Ext Price

Weight (lbs.) Sales Tax Subtotal
Current Products Selected
Previous Products Submitted
Subtotal:
Sales Tax:
Shipping:
(more below) Grand Total:

Ship To:

Name:
Address1:
Address2:
City: State:
Postal Code: Country:
Phone Number: Fax:
E-Mail:

Payment:

Credit Card Below I Will Call I Will Fax

Name: Company:
Number: Expiration:

Contact Westfork Software to report problems with this orderform.
Contact Evergreen Brewing Supply with questions about your order.

Main

Last Update: 7/7/98 by Westfork Software