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Atiu Coffee - Organic Gourmet Coffee Mail Order Form

We have prepared this order form for you to fill in and send to us. We regret that we cannot except oders for less than NZ$ 50.00. Your shipment must be insured, insurance costs NZ$ 1.50 + NZ$1.00 per each NZ$ 100.00 of insured value and has to be added to the total amount resulting from your order.

For customers in the U.S.A., a surcharge of US$ 19.95 applies for prior registration with US FDA, US Customs and US Border Protection Service.


Atiu Coffee Bag size Price Please send Bag Size Price Please send
Dark Roast (ground) 250 gr $ 9.50 bags 850 gr $ 23.40 bags
Dark Roast (whole beans) 250 gr $ 9.50 bags 750 gr $ 20.60 bags
Medium Roast (ground) 250 gr $ 9.50 bags 1 kg $ 25.70 bags
Medium Roast (whole beans) 250 gr $ 9.50 bags 1 kg $ 25.70 bags


Please fill in your details
Surname, Name
Postal Address
City
State / Region
Zip / Postal Code
Country
Phone
Fax
Email
Shipping Air Mail
Surface Mail
   
(for Fax)* please cross out what is not applicable Your signature and date :

If you don't want to use the Internet facilities we offer you, you can also send us a copy of this completed form by

Postage Australia/New Zealand/
Oceania 		America/
Canada 		Europe
Air Mail up to 1 kg $ 14.90 $ 25.80 $ 41.30
each additional 500 gr $ 4.90 $ 12.10 $ 19.50
Surface Mail up to 1 kg $ 8.30 $ 9.40 $ 10.20
up to 3 kg $ 15.20 $ 17.90 $ 19.70
up to 5 Kg $ 20.70 $ 27.30 $ 31.90
up to 10 kg $ 36.20 $ 47.70 $ 59.50

For secure payment with your credit card, please click here.


Certificate of FDA Registration