Instructions: Print out these two pages (fax cover sheet and... complete both pages and fax to the Shamrock Group at...
Instructions: Print out these two pages (fax cover sheet and order form), complete both pages and fax to the Shamrock Group at 612.824.1974. Refer to the Shamrock Group Price Pages or pricing provided to you by your Shamrock Group Account Manager for costs. You will receive an acknowledgement of receipt from the Shamrock Group via fax. Account No. ___________________________Date ___________________ Sold to _______________________________________________________ Company Name _______________________________________________ City _______________________________ State ________ Zip _________ Phone _________________________ Fax __________________________ On-Account Charge (No discount) VISA* MasterCard* American Express* Discover* * Shamrock Group offers a 2% discount when you pay for your order using a major credit card. Credit Card No. _______________________________________________ Credit Card Expiration (00/00)_________________ CSC _______________ Additional notes _______________________________________________ _____________________________________________________________ _____________________________________________________________ Please fax this page and the Shamrock Group Order Form page to 612.824.1974. Shamrock Group Product Order Form / Page 1 Shamrock Beverages Qty Cost 30099 Cola Barista Fria Specialty Mixes Qty Cost 30343 Chai Tea Island Oasis 12qt/case 30119 Diet Cola Qty Cost Qty Cost Gas Cylinders HAZMAT Qty Cost 30116 50lb Gas Drums UN 1013 Harvest Run Juices 3-1gal btles/cs 30305 100% Orange Qty Cost 30306 100% Pineapple 30134 Lemon Lime 30029 Banana 30307 100% Apple 30136 Diet Lemon Lime 30030 Ice Cream 30308 Cranberry 30138 Lemon Beverage 30031 Ice Cappuccino 30309 Lemonade 30139 Lemonade-Pink 30032 Wildberry 30310 Pink Grapefruit 30311 Kiwi Strawberry 30144 Ginger Ale 2.5gal 30033 Margarita 30103 Margarita 30035 Peach 30104 Margarita 4gal/case 30036 Pina Colada 30105 Orangeade 30037 Raspberry 30108 Quinine 5gal BIB 30039 Strawberry Pre-Mix Tanks 30109 Quinine 2.5 gal 30040 Sweet & Sour 30059 Premix Coca-Cola 30102 Diet Quinine 2.5gal 30041 Mango 30111 Root Beer 30042 Non-Fat Yogurt 30060 Premix Diet Coke 30160 Diet Root Beer, 2.5gal 30043 Lemonade 30061 Premix Sprite 30114 Lemon Sour 2.5gal BIB 30044 Guava 30062 Premix Club/30063 Tonic 30113 Lemon Sour 5gal BIB 30045 Hurricane 30065 Premix 7Up 30122 Alpine Mist 30046 Payaya 30067 Premix Squirt 30176 Diet Alpine Mist 2.5gal 30047 Passion Fruit 30141 Diet Alpine Mist 5gal 30048 Mojito 30124 Strawberry Citrus Sun Juices 3gal/BIB 30159 Grape Soda, 2.5gal 30016 Orange Juice 30161 SunGlo Lime 30017 Cranberry Cocktail Qty Cost 30411 50lb Gas Return 30158 Dr. Better 30018 Texas Bloody Mary5gal 30117 20lb Gas Drums 30162 Fruit Punch, 2.5gal 30019 Apple Juice 30412 20lb Gas Return 30020 Fruit Punch 30120 Nitrogen-Large 30021 Grape Juice 30414 Nitrogen Gas Return 30175 Cream Soda, 2.5gal Coca-Cola Syrups 5 gal/BIB Qty Cost 30003 Coke Classic 30022 Sweet & Sour 30126 Alley Gas 30004 Diet Coke 30048 Prune Juice 100% 30413 Alley Gas Return 30006 Cherry Coke 2.5gal 31017 Reduced Color Cranberry Red Parrot Juices 3gal BIB 30007 Diet Sprite 2.5gal 30129 Helium Qty Cost UN 1013 UN 1066 ALIGAL UN 1013 30416 Helium Gas Return 30009 Mr. Pibb 2.5gal 30090 Bloody Mary Frozen Mixers BIB 30010 Sprite 30157 Grapefruit Juice 30130 Frozen Carbonated Cherry 30092 Pineapple Juice 30131 Frozen Carbonated BlueRasp 30014 Mellow Yellow 2.5gal Barista Fria Specialty Mixes Qty Cost Cost 30093 Clamato Bloody Mary 30330 Caffe Latte 30095 100% Orange Juice 30331 Mocha 30097 Krazy Parrot Energy Miscellaneous Weekend/Special Delivery Fee 30332 Caramel Latte 30333 Wildberry Qty Equipment Rental Florida First 2-128oz Frozen Qty Cost Hazmat Tank Maintenance Fee Fuel Surcharge 1.00 30334 Strawberry 30023 Apple Juice 30335 Mango 30024 100% Orange Juice Invoice Total 30336 Pina Colada 30025 Grapefruit Accepted by _________________________ 30337 Banana 30026 Lemonade 30338 Vanilla Ice Cream Base 30027 Pineapple 30339 Chocolate Beverage 30028 Cranberry 30342 Non-Fat Yogurt 30051 Raspberry Lemonade Shamrock Group Product Order Form / Page 2 Specialty Beverages Qty Cost Teas 30340 Orange Bang Conc. 3gal BIB 30261 B.W. Cooper Premium Unsweetened 30341 Orange Bang Conc. 6-64oz btles/cs 30263 B.W. Cooper Green Sweet 3gal 30142 Horchata 3gal BIB 30208 Nesta 30345 Hochata 6-64oz btles/cs 30264 Nesta Raspberry 30217 Minute Maid Frzn Pomegrnt Berry 12-32oz 30146 Tea On The Rocks 6-32oz btles 30218 Minute Maid Mango S/Stable 12-46oz 30219 Minute Maid Strawberry S/Stable 12-46oz 30220 Minute Maid StrawBan S/Stable 12-46oz 33000 Roaring Lion 3gal BIB 30130 Frozen Carbonated Cherry 2.5gal 33001 Roaring Lion 24-12oz cans 30130 Frzn Carb. Blue Raspberry 2.5gal 33002 Sugar Free R/Lion 1galBIB Wellbeing Water Products Roaring Lion Qty Cost Qty Cost Qty Cost 33003 Roaring Lion 24-16.9oz bottles 33004 Sugar Free R/Lion 24-16.9oz bottles 30225 Honey Consist. Thickened Water 30226 Nectar Consist. Thickened Water Ace Ice Products 30216 Reverse Osmosis Water 5gal Shamrock Gases Cost Min. Delivery Qty Cost 10013 5lb bag, Mini Cubes 56bags 0.85/ea 30001 Bulk CO2 10004 18lb bag, Mini cubes 20bags $3.00/ea 30126 Beer Gas (75%N: 25% CO2) 10005 18lb bag, Crushed 20bags $3.50/ea 30116 CO2 Gas Drum 50lb 10009 30lb bag, Mini Cubes 10bags $5.00/ea 30117 CO2 Gas Drum 20lb 10010 35lb bag, Crushed 10bags $5.50/ea 30120 Nitrogen 10008 300lb Specialty/Unsculptured Block Qty 1-3 blocks 30129 Helium 30163 Oxygen Gas Cylinders 30116 50lb Gas Drums HAZMAT UN 1013 30411 50lb Gas Return 30117 20lb Gas Drums UN 1013 30412 20lb Gas Return 30120 Nitrogen-Large UN 1066 Qty Cost $65.00/ea 4-9 blocks $55.00/ea 10+ blocks $45.00/ea 10027 Specialty/Sculptured Block 10001 10lb Dry Block 50lbs $1.00/lb 10007 Dry Pellets 50lbs $1.00/lb 10002 10lb block, solid square 20blks 10003 Bulk 30414 Nitrogen Gas Return 30126 Alley Gas ALIGAL 30413 Alley Gas Return 30129 Helium $225.00/ea UN 1013 30416 Helium Gas Return Miscellaneous Weekend/Special Delivery Fee Equipment Rental Hazmat Tank Maintenance Fee Fuel Surcharge Invoice Total Accepted by _________________________ $2.00/ea Call for pricing
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