ORDER FORM (please print)

Send in by mail to:
The Berghoff Restaurant
17 West Adams
Chicago, IL 60603
or by FAX to:
(312) 427-6549
Payment by credit card only.
American Express/Visa/Master Card
Please allow 2-4 weeks for delivery.
Prices subject to change.
THANK YOU!
ITEM # DESC. QUANTITY SIZE PRICE AMOUNT
 
 		          
 
 		          
 
 		          
 
 		          
 
 		          
 
 		          

Shipping and Handling Charge:______________________________

TOTAL:______________________________
$0.01-$19.99 add $8.50
$20.00-$39.99 add $10.50
$40.00-$59.99 add $11.50
$60.00-$79.99 add $12.95
$80.00-$99.99 add $14.95
$100.00 or more add $17.95
Out of state packages will be charged an additional $ 4.00

Credit Card _________________________________________________
(VISA, AMEX, MC)

Card Number _________________________________________________

Exp. Date ____________________________________________________


NAME____________________________________________________________

ADDRESS_________________________________________________________

CITY_____________________________________________________________

STATE__________________________ ZIP______________________________

PHONE___________________________________________________________

SIGNATURE_______________________________________________________