Email this form to: flavors@riosyrup.com

Rio Syrup Company, Inc.
2311 Chestnut Street, Saint Louis, Missouri 63103-2298 USA
800-325-7666 (ph.)         314-436-7707 (fax)

CONTACT INFORMATION:
Date:

Name:

Phone:

Email:

Address:

City, State, Zip:

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ORDER INFORMATION
(
Consult the Flavor Finder section to select the products & flavors you would like to order or the RIO Home Kits and Packs):

Product Code

Size

(Gal/Qt/

BiB5/BiB2.5)

Product(Syrup/Conc/Slush Base/Slush Flvr)

       Flavor









































Rio Syrup will email you with shipping cost if different than that listed on RIO Home Kits and Packs page.

 
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PAYMENT INFORMATION:

MC VISA DIS AX




SIGNATURE:

CARD#: EXP. DATE:



To Order by Mail with CHECK OR MONEY ORDER please make payable to: RIO SYRUP COMPANY