CUSTOMER SPECIAL REQUEST

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Hilltop

CUSTOMER SPECIAL REQUEST Customer: Please fill out the box below and return it to the store.

Customer Name: Date Ordered:

Phone: Date to Pick Up:

Item you would like us to special order:

Item you would like us to carry as an everyday product:

For Store Use: Request Received By: Request Submitted To: Date Product Ordered: Date Product Received: Location of Product for Customer Pickup: Date Customer was Called for Pickup: First Call: Second Call: Third Call: Special AD Pricing and/or Discount customer is to receive: