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ORDER FORM
FAX OR MAIL THIS FORM TO:
Merle & Jackie Young, PO Box 65, West Glover, VT 05875.
Phone: (802) 525-4947, (802) 673-8190, (802) 673-8194.
Please Provide the Following Information.......
First Name ________________________________
Last Name _________________________________
Street Address ________________________________
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City _________________________________
State/Province _________________________________
Zip/Postal Code ____________________
Country __________________
Work Telephone _______________________________
Home Telephone _______________________________
E-Mail Address _______________________________
(Shipping if Different from Above)
Full Name _____________________________________
Street Address __________________________________
City __________________________________________
State/Province __________________________________
Zip/Postal Code ______________________
Country _____________________
Comments, Questions....___________________________
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QTY DESCRIPTION PRICE
_________ ___________________ ___________
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Special Requests.... ____________________________________
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How would you like to Pay for your order?
We will Ship when Payment is confirmed, checks must clear first. Method
of Payment, Please Select:
Sending Check___
Money Order___
Visa___
MasterCard____
Card # _________________________________
Exp. Date _____________________
Our Fax # 1-802-525-1176
Telephone # 1-802-525-6683
Young View Farm
P.O. Box 57
118 County Road West Glover, VT 05875
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