Customer Order Form

Hombres™ Foods - Customer Order Form

Phone/FAX#: (512) 303-4558 or Toll Free # (877) 446-6273
Order Date:___________        Email Address: __________________________________
Note: We cannot ship to P.O. Boxes. Please read terms at bottom.
Bill To:______________________________________         Ship To:_______________________________________
               ______________________________________                        _______________________________________
               ______________________________________                        _______________________________________
               ______________________________________                        _______________________________________

Phone # (        )                                                                                          FAX # (          )
Credit Card Information:   Circle Type:     VISA    MC           (Please Print)
Card # ______________________________________                           Expiration Date (mm/yy) ___________

Credit card information off of your credit card statement (for security purposes).
Name __________________________      Address______________________________
Zip Code ______________                            Signature_____________________________

Item #	Description	Unit Price	Qty	Total Price
	SALSAS
01012	Texas Chipotle Salsa (Med) 12.5oz	$5.50
01013	Texas Chipotle Salsa (Hot) 12.5oz	$5.50
01022	Texas Campfire Verde Salsa (Med) 12oz	$5.50
01042	Texas Smoked Habanero Salsa (Med) 12.5oz	$5.50
01043	Texas Smoked Habanero Salsa (Hot) 12.5oz	$5.50
01051	Passion Peach Mango Salsa (Mild) 12.5oz	$5.50
01062	Fiesta Fire~Roasted Salsa (Med) 12.5oz	$5.50
	DRY MIXES
02013	Chipotle Chili Fixin’s 4.25oz	$5.50
03043	Southwest Cornbread Fixin’s 11.5oz	$5.50
	DIP MIXES
04012	Sassy Spinach Dip 1.2oz	$3.95
04023	Onion~Garlic Chipotle Dip 1.4oz	$3.95
04032	Jalapeño Cilantro Dip 1.2oz	$3.95
04041	Dilly Ranch Dip 1.4oz	$3.95
04052	Jazzy Shrimp Bisque Dip 1.2oz	$3.95
04062	Bayou Cajun Crab Dip 1.2oz	$3.95
04071	Sun~Dried Tomato Basil Dip 1.3oz	$3.95
04082	Green Chile Cilantro Dip 1.3oz	$3.95
	BARBECUE
07113	Smoky Chipotle Beef & Fajita Rub 4.3oz	$4.95
07213	Smoky Chipotle Pork & Chicken Rub 4.5oz	$4.95
	SOUPS
08001	Tex-Mex Tortilla Soup Mix 3.25oz	$5.95
08061	Zesty Southwest Queso Soup Mix 4.5oz	$5.50
08071	Creamy Herb & Cheese Potato Soup Mix 4.5oz	$5.50
	SWEETS
09091	Cappuccino Chipotle Brownie Mix 1lb 4oz	$6.95
	*Total (not including shipping)*

1. Minimum order is three items - any combination.
2. Orders ship via UPS ground unless other arrangements are made.
3. Shipping charges computed and added to order at time of shipment.
4. Breakage must be reported within 10 days from date of receipt for credit or replacement product.
5. For other important terms (shipping, etc.) refer to company fact sheet.
6. All prices subject to change without notice.

SALSAS

DRY MIXES

DIP MIXES

Jazzy Shrimp Bisque Dip 1.2oz

BARBECUE

SOUPS

Tex-Mex Tortilla Soup Mix 3.25oz

SWEETS