Please rush my order for the items I have requested. I am paying for this merchandise by:

(Please Choose One)

This checkout page is located on a SECURE server.  All of the information you enter below will be encrypted during the processing of this transaction, and, your credit card information will not be saved by our system.

We believe that submission of your credit card information over the Internet is as safe as handing your card to a clerk at a retail store or to a waiter/waitress at a restaurant, however, if you do not wish to transmit your credit card information over the Internet, enter the information below, print this form and mail it to us at the location listed below.
Card Owner:
Card Number:
Card Exp Date:
CVV Number:
Back of Credit Card
(On back of credit card)
Check of Money Order

 
To pay by Check or Money order, complete the information below and mail this form with your payment to the location listed below.  Make checks payable to Grape Creek Country Market.

(Please fill in all the information below)

Full Name:
(as it appears on your credit card)
Billing Address:
City:
State/Prov:
Postal Code:
Country:
Phone:
Email:
Instructions: Any special instructions you wish to sent to our customer service representatives:
How did you find our web site?

SHIPPING INFORMATION (if different from above)
Ship To Name:
Shipping Address:
City:
State/Prov:
Postal Code:
Country:

 

 

If you do not wish to transmit your credit card information over the Internet
you can print this form and mail it or fax it to:

Company
Street
City, State Zip 
Phone: (000) 000-0000
Fax: (000) 000-0000

Thank you for your business.

PLEASE READ CAREFULLY BEFORE SUBMITTING THIS ORDER

Clicking below will take you to a form verifying your order.
Once you arrive at that page, using the "back button" will not cancel your order.

Refusal to accept a shipment does not constitute a cancellation of your order or entitle you to a refund.

By submitting this order form, you are acknowledging that you are authorized to charge on the above credit card, and, you are authorizing _____________________ to debit your charge account by the amount shown above.