ORDER FORM 2.5oz                                       

  PURCHASER

  Name:   

  Street:            

  Town:                         State                          Zip:        

  Phone #:                               Email:                  

  SHIP ORDER TO:

  Name:

  Street:          

  Town:                            State:                             Zip:   

  Phone #                                  Email

  SHIPPING AND HANDLING (check time zone in which package will be delivered):

  TIME ZONE: 

         EASTERN_______CENTRAL_______MOUNTAIN_______PACIFIC_______

  SHIPPING COST:    

          EASTERN______CENTRAL_______MOUNTAIN_______PACIFIC_______

        2 DAYS $15.00       2 DAYS $18.00      3 DAYS $36.00                3 DAYS $40.00

  Orders for Alaska or Hawaii email for quote:

  REQUESTED MONDAY SHIP DATES:  

  MONTH ______________ DATE__________

        Order here for ONE case of 2.5 oz little tubs (each case is a separate order):

        Total 2.5ozlittle tubs (must equal 24 tubs):  ______     

  ORDER QUANTITY by: little tubs 2.5oz size tubs (24 count):

      Squire Mtn Original CHEDDAR Tub Cheese             

      Squire Mtn OLIVE & PIMENTO Tub Cheese           

      Squire Mtn GARLIC & HERB Tub Cheese               

      Squire Mtn HORSERADISH Tub Cheese                 

      Squire Mtn BACON CHEDDAR Tub Cheese             

      Squire Mtn PORT WINE Tub Cheese             

                                                Product cost:       $   60.00

                                                    Shipping cost: $_____________ 

                                                     SUB-TOTAL:  $_____________

                                                    less coupon:    $_____________

                                                ORDER TOTAL:  $_____________

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MAIL TO:  SQUIRE MOUNTAIN, LLC,  P.O. BOX 149, STANDISH, ME.04084

MAKE CHECK OR MONEY ORDER PAYABLE TO  SQUIRE MOUNTAIN ,LLC