Theme Basket Ordering Form

Due to technical issues, our order forms are currently inoperative.
Please call us directly at (719) 471-1133 and we will be happy to assist you.

Select item, enter quantity and a price category.
You will be contacted within 24 hours for verification and special instructions.

** We reserve the right to make substitution
with the products based on product availability.

Nuts Over Chocolate Qty Price each	Coffee Lover Qty Price each	Time for Tea Qty Price each
Organics Qty Price each	Gourmet Qty Price each	Snack Fest Qty Price each

Billing Information
* Name
Company Name
* Billing Address
Billing Address
* City
* State
* Zip
* Phone
* Email address
* Confirm Email
* Required Information
*Delivery Information if different from above*
Name
Company Name
Address
Address
City
State
Zip
Phone

Special Instructions Delivery Card Message Delivery Date:
Credit Card Information
* Credit Card Discover Card MasterCard VISA
	* Name on Card * Credit Card Number	Exp. Date	Month	Year

A charge of $10 will be added to your order for Metro delivery.

We will call you to confirm your order within 24 hours.

1219 W. Colorado Ave.
Colorado Springs, CO 80904
e-mail: info@The-Basket-Case.net
Ph 719-471-1133 FAX 719-475-1700