Order Form

 Firehouse Dips

2316 7th St.

Peru, IL 61354

www.firehousedips.com

  Quantity                       Product                                 Cost

 __________                       Wow...That's Garlic              X $ 4.00    ______ 

__________                        Roasted Garlic                     X $ 4.00    ______ 

__________                        BLT                                      X $4.00     ______ 

__________                        The Hog Ranch                   X $4.00     ______ 

__________                        Tomato and Horseradish     X $4.00      ______

__________                        Dilly-ishous                          X $4.00     ______ 

___________                      Drunken Hot Wing                X $4.00    ______

___________                     Aparche                                X $4.00    ______ 

___________                      Toasted Onion                    X $4.00    _______

___________                      I love Pumpkin Pie Dip         X $ 4.00    ______    

___________                      Banana                                  X $ 4.00   ______

___________                      Usimarit (Tiramisu)                X $4.00   _______  

___________                      Firehouse Signature Rub       X $ 5.00  ______     

                                                       Add Shipping and Handling     $________

                                                           1-10 Pkgs       $ 4.00

                                                           10-20 Pkgs     $ 7.00

                                                            + 20 Pkgs       $10.00

             Total Amount Enclosed                            $________

        Check or money order made payable to Wally Curtin

                   Name       __________________________

  Shipping Address         __________________________

    (No PO boxes)          __________________________

                                 __________________________

 Contact Phone Number  __________________________

 Email  Address              __________________________

  *No S&H on local delivery (LPO Area) with $20 min order*