Phone: 941-756-6999 Fax: 941-756-6999 Email: newfarm@fbconnect.net
Ship to Name: Date:
Address:
City/State: Zip:
Phone: Area code( )
QTY
UNIT PRICE
AMOUNT
(MINIMUM $9 SHIPPING & HANDLING PER ORDER)
Orders Will Be Delayed If Proper Shipping & Handling Is Not Included
FLORIDA RESIDENTS ADD 7% SALES TAX
(U.S. FUNDS ONLY)
Check enclosed (Make it payable to New Farm)
Please charge to my: MASTERCARD VISA
Account #: Expiration Date:
Signature: