Fire Mountain Foods                           Reseller Order Form

17505 Mardee

Lake Oswego, OR 97035

503-697-1428

SKU                                                            Unit wt     Unit $     Qty     $Total

Hot Pepper Relish

8.5 oz Jar -          UPC 8-93534-00001-7         16oz        $3.90 x  ____ =_______

  12 pak –               UPC 8-93534-00041-3       12.4 lbs    $46.80 x  ____ =_______

Sweet Jalapeno Relish

8.5 oz Jar -          UPC 8-93534-00002-4         16oz        $3.90 x  ____ =_______

  12 pak –               UPC 8-93534-00042-0       12.4 lbs    $46.80 x  ____ =_______

                                                                               Total $         __________

Terms ___________________

Case Cube = .25   Case size = 12”x9”x4”   Pallet T/H = 17x10 = 170 cases

Customer name _________________________________________

Approved by ____________________________________________

Signature ______________________    Date __________________

Prices FOB Portland, OR.

Please check with us for additional freight charges to out of area shipments. UPS and common carrier shipping available.