CWR0810
   
  Would you like to purchase a St. Elmo's Signature Item?

Fill out this form, print it and then mail or fax us your order or inquiry.
Send your check or money order with the form to the address listed at the bottom.
     
Date:
  Email:
  Name:  
  Street Address:  
     
  City:  
  State: Zip:
   

Shipping Address (If different than billing)

  
  Name:  
  Street Address:  
     
  City:  
  State: Zip:
 
  Coffee (12oz, whole bean)      
  St. Elmo’s House Blend $9.99
  St. Elmo’s Decaf $10.99
  St. Elmo’s Espresso Blend $9.99
  St. Elmo’s Decaf Espresso $10.99
  Shirts and Tees      
  Please inquire about the availability of shirts and tees    
         
Total order
  Credit Card Information    
  Please indicate your payment choice: VISA     MC    AmEx    Discover
  Name on Card  
  Card Number  
  Expiration Date  
       
 

Send your money order or cashier's check along with a Printed Copy of this form to:

St. Elmo's Coffee Pub
2300 Mount Vernon Avenue
Alexandria, Virginia 22301

Questions about ordering can be asked at NoraPartlow@Yahoo.com