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MileAway Farm Fax Order Form
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Your Contact Information

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: __________

Zip Code:

_____________

Daytime Phone:

____________________________________________________

Evening Phone:

____________________________________________________

Email:

____________________________________________________

 

Please call us at 207-342-2003  with your payment details.  We accept MasterCard, Visa, and Discover.

Order Information

Quantity

Description

Price

Total Price

 

24 Inch Diameter Christmas Wreath

$29.95+ Shipping

 

 

26 Inch Diameter Christmas Wreath

$38.95+ Shipping

 

 

28 Inch Diameter Christmas Wreath

$47.95+ Shipping

 

 

30 Inch Diameter Christmas Wreath

$50.95+ Shipping

 

 

Centerpiece

$29.95+ Shipping

 

 

Garland (9 foot)

$29.95+ Shipping

 

 

8 1/2" Balsam Fir Pillow

$17.95+ Shipping

 

 

Grand Total

 

_______ +Shipping 

Ship To Information

Order #1

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________

From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________

Order #2

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________

From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________

Order #3

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________

From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________

Order #4

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________

From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________

Order #5

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________

From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________