Please fill out this form and Submit
for questions please call
(904) 352-9676

Sold To:
Name: Day Time Phone:(  )
Street Address:
City:   State:    Zip: 
Ship To:
Name: Day Time Phone:( )
Street Address:
City:   State     Zip 
  Quantity Name of Item Price Each Total Price Ship/Hand Total
Shipping Insurance (OPTIONAL) Add $1.95  
+ Florida Sales Tax (Florida residence only) 7%  
Total Order  
Payment Method
Please Circle One: Master Card Visa Discover Payment Enclosed
Please make check or money order payable to:
Kitchen King Wholesale Distributors

(U.S. Funds Only, DO NOT SEND CASH)
Master Card, Visa or Discover Number:
Expiration Date:       Signature: 
Credit Card Fraud is a crime and will be prosecuted to the fullest extent of the law
If you would like e-mail confirmation of shipment of your order, please provide e-mail address

(You will be able to print your order, after it is submitted.)
Thank You for Your Order!



You can also email or snail mail this competed form to:
Burner Cover King
5345 Long Branch Road
Jacksonville, FL. 32234
Phone/Fax: (904) 352-9676

Website Maintained by: Stacy Cagle