Order Form, Britan's, Proprietors of Select British and South African Groceries & Confectioneries, Tampa, Florida

* Please print this page to fax or mail your grocery order *
Grocery Order Form
Date:
Bill To:	Ship To (if different from Bill To):
Name:	Name:
Address:	Address:

Phone #:	Phone #:

Credit Card #:	Expiry:
Signature:	Credit Card Type: