Oval:  
Text Box: P.O. Box 1565
300 West Broad Street
Griffin, Georgia 30224.  USA
 
 
 
 
 
 
Text Box: Email: sales@dinnisselect.com
Phone: (770) 227-0330 ext 102
www.dinnisselect.com

 

 

 

 

Name:

CHARGE CARD:        VISA □        MASTER CARD □         Amex □          Discover □ 

SHIP TO Address:

Name on Card:

 

Card Number:

City:                                                        

Expiration Date:                 /                  Security Code:

State:                                                           ZIP:

Card Billing Address:        □   Same as Shipping

Phone:                                                                       

 

E-Mail:

City:                                                   State:         ZIP:

Line

                PRODUCT

PRICE

QUANTITY

      TOTAL COST

1

   Bang Bang Sauce

$5.0

 

 

2

   Cajun Remoulade

$5.0

 

 

3

   Bloomin Sauce

$5.0

 

 

4

   Curry Dip & Sauce

$5.0

 

 

5

   Spicy Cucumber

$5.0

 

 

6

   Dill Delight

$5.0

 

 

7

   Esperanza

$5.0

 

 

8

   Ginger Ranch

$5.0

 

 

9

   Ginger Teriyaki

$5.0

 

 

10

   Honey Mustard

$5.0

 

 

11

   Hot Sauce with Cilantro

$5.0

 

 

12

   Italian Herb Vinaigrette

$5.0

 

 

13

   Peach Balsamic Vinaigrette

$5.0

 

 

14

   Mesquite Barbecue Sauce

$5.0

 

 

15

   Orange Blossom Honey Mustard

$5.0

 

 

16

   Rib Sauce

$5.0

 

 

17

   Tennessee Bourbon Barbecue Sauce

$5.0

 

 

18

   Terrific Tamarind

$5.0

 

 

19

    Very Hot Sauce

$5.0

 

 

20

    Wasabi Sauce

$5.0

 

 

21

   Sweet Bourbon Sauce

 $5.0

 

 

22

 

 

 

 

23

   Gift Crate – Spicy Food Lovers

$28.18

 

 

24

   Gift Crate – Barbecue Lovers

  $28.18

 

 

25

   Gift Crate – Any 3 Jars ( Write product names below)

  $28.18

 

 

26

                                                                    SUB TOTAL:

 

 

 

27

    Georgia Residents add 7% Sales tax:

 

 

 

28

   SHIPPING (click here to get shipping cost):

 

 

 

29

                                                                     TOTAL: