Impact Coffee Order Form

* = required field

Order freshly roasted Impact Coffee by filling out this form.
First & Last Name*
Company Name (if applicable)
Phone*
Email*
Fax
Billing Address
City, State, Zip Code
Mailing Address (if different from Billing Address)
City, State, Zip Code

Below, please select your favorite Impact Coffee and the roast type you'd like. Coffees are listed by origin. All coffees are $13.00 per pound (lb). If you would like more than one pound of a type, please list that in the comment section below. If you do not note this in the comments, you will receive only one pound of each of the types you select.

PLEASE NOTE! Place order by 5pm on Saturday for pick up the following Tuesday after 2pm in the C-Store.

Brazil
Costa Rica
Ethiopia
Guatemala
Kenya

Below, please select whether you would like your coffee beans whole or if you would like them to be ground for you. If you have different requests for different types of coffee, please list that in the comments section.

Grind Option*

List any comments you have about the above order below. For example, if you'd like to order multiple pounds of a certain type, please list that here.

Comments
  
Impact Coffee logo.
Impact Coffee Bar in Downtown Decorah.