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Costco Order Form

COSTCO Service now provided by Heavenly Helpers
1525 W 12 Street, Suite 11
(541-991-1750)
Order/Delivery the 2nd and 4th Thursdays/Fridays of the month)
(Pick up at covered delivery dock, East end of building)
(Use the TAB key to advance to the next line in the form)
  
Date:   Page No:   Office / Residence:
Contact Name:   Phone Number:   Fax Number:  
Item No. Qty Description Price Delivered
Availability and prices subject to change without notice. Please
call 541-285-2010 for current prices or items you do not find in
the catalog. (Costco On Line is not available through this service)