Flavor Burst Soft Serve Syrup Flavorings Order Form
Flavors are listed in order of popularity as ranked by % values
|
Flavor |
Qty |
Flavor |
Qty |
Flavor |
Qty |
Flavor |
Qty |
| Strawberry 16.6% |
|
Green Apple 4.6 |
|
Butterscotch 2.5% |
|
Coffee 'n' Crème 1.0% |
|
| Chocolate 16.1% |
|
Bubblegum 4.3% |
|
Banana Ripple 2.2% |
|
Pistachio Nut 0.9% |
|
| Mocha Cappuchino 7.6% |
|
Tropical Orange 4.0% |
|
Pina Colada 1.7% |
|
Cool Mint 0.9% |
|
| Blue Goo 7.1% |
|
Purple Grape 3.4% |
|
Watermelon 1.6% |
|
Other: |
|
| Butter Pecan 5.7% |
|
Caramel 3.4% |
|
Cheesecake 1.1% |
|
|
|
| Raspberry 5.7% |
|
Black Cherry 2.6% |
|
Lime 1.0% |
|
|
|
Please ship the above flavor selection. I hereby authorize Taylor Equipment Distributors, Inc. (Taylor AFS)
to charge my credit card or my account for products or services as provided. Tax, Shipping and Handling are extra.
Location/Business Name_______________________________________________
Street: ______________________________________________________________________
City:________________________________________________ State: ___________________
Zip Code: ___________ - _________ Telephone: ( ) _____ - _________
Fax: ( ) _____ - _________ Email ___________________________
Signature____________________________ Date _____________
Printed Name ___________________________________________
Credit Card: ( ) VISA ( ) MasterCard Expiration Date: ______ /______
Name on Credit Card ___________________________________________________________
Credit Card Number: ______________________________________ Security Code __________
Credit Card Billing Address (if different from above):
Street: ____________________________________________________________________
City:________________________________________________ State: _________________
Zip Code: ___________ - _________ Telephone: ( ) _____ - _________
Fax Credit Card Transaction Receipt to Fax Number: ( ) _____ - _________
Bill to my Account # ______________________________________
If you have any questions please contact the Parts Department at 301-773-2700.
PLEASE FAX THIS COMPLETED FORM TO 301-773-2720.
