Flavor Burst Soft Serve Syrup Flavorings Order Form

Flavors are listed in order of popularity as ranked by % values

  • Flavor :
  • Qty :
  • Strawberry 16.6%
  • _____
  • Green Apple 4.6
  • _____
  • Butterscotch 2.5%
  • _____
  • Coffee ‘n’ Crème 1.0%
  • _____
  • Chocolate 16.1%
  • _____
  • Bubblegum 4.3%
  • _____
  • Banana Ripple 2.2%
  • _____
  • Flavor :
  • Qty :
  • Pistachio Nut 0.9%
  • _____
  • Butter Pecan 5.7%
  • _____
  • Caramel 3.4%
  • _____
  • Cheesecake 1.1%
  • _____
  • Raspberry 5.7%
  • _____
  • Black Cherry 2.6%
  • _____
  • Lime 1.0%
  • _____

Please ship the above flavor selection. I hereby authorize Taylor Equipment Distributors, Inc. (Taylor AFS) to charge my credit card or my account for products or services as provided. Tax, Shipping and Handling are extra.

Location/Business Name: ______________________________________________________________

Street: _____________________________________________________________________________

City: _______________________________________________________________________________

State: ______________________________________________________________________________

Zip Code: ___________________________________________________________________________

Telephone: ( ) ________________________________________________________________________

Fax: ( ) _____________________________________________________________________________

Email: ______________________________________________________________________________

Signature: __________________________________________________________________________

Date: ______________________________________________________________________________

Printed Name: _______________________________________________________________________

Credit Card: ( ) VISA ( ) MasterCard Expiration Date: _______________________________________

Name on Credit Card: __________________________________________________________________

Credit Card Number: ___________________________________________________________________

Security Code: _______________________________________________________________________

Credit Card Billing Address (if different from above):

Street: _____________________________________________________________________________

City: _______________________________________________________________________________

State: ______________________________________________________________________________

Zip Code: ___________________________________________________________________________

Telephone: ( ) ________________________________________________________________________

Fax Credit Card Transaction Receipt to Fax Number: ( ) _____________________________________

Bill to my Account #: __________________________________________________________________

If you have any questions please contact the Parts Department at 301-773-2700.

PLEASE FAX THIS COMPLETED FORM TO 301-773-2720.