Name:
E-mail:
Address:
City:
State:	Select From This List Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Home Telephone:
Office Telephone:
Fax:

How would you like us to contact you?
Office Phone	Home Phone	E-mail

When is the best time to contact you?
Daytime	Evening	Weekend

I am interested in the following: (check all that apply)
	Becoming a wholesale distributor of Jubilations Cheesecakes
	Using Jubilations Cheesecakes in my foodservice operation
	Selling Jubilations Cheesecakes in my retail establishment
	Selling Jubilations Cheesecakes in my catalog business
	Selling Jubilations Cheesecakes on my web site
	Using Jubilations Cheesecakes for my company's employee gift
	Sending Jubilations Cheesecakes to my firm's clients
	Being reminded of dates to send Jubilations Cheesecakes as gifts
	Giving a customer testimonial for Jubilations Cheesecakes.
Comments: Tell us what you think. And if you wish to be reminded of birthdays or other events, include the name of the person(s), type of event, and date -- we'll send you an e-mail reminder you two weeks ahead of time so you can celebrate special occasions with a Jubilations Cheesecake.

Refer a friend and get 10% off:

Perhaps you know someone who would like to know about Jubilations. Enter your friend's name and contact information below, and we'll e-mail them -- and you -- a 10% off coupon good on your next purchase.

Friend's First Name
Friend's Last Name
Friend's E-mail: