TPGS, Corp, dba The Puako General Store

69-1649 Puako Beach Drive,

Kamuela, HI 96743

808.882.7500

 

Guest Name ____________________________________

Puako/Waialea Bay Address ____________________

_________________________________________________

Cell Number ____________________________________

Date of Delivery _________________________________

Food and Beverage Delivery

List items here:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

I authorize The Puako General Store to deliver the listed items to the home I will be occupying. I am 21 years of age or older.

____________________________________________

Guest signature

In accordance with state law, we are required to have proof of age on file, as well as your home address and contact phone number. Please fax proof of age along with this signed delivery form to 808-882-1395

Payment for all items must be made in the store the day after delivery

 

Below to be completed by store staff:

DOB on file _______Yes

Form of ID _____________________________

Date received _____________

Signed ____________________________

Owner or manager signature