Wallingford Farm

Wallingford Farm Order Form

BUYER
Name: ______________________________
Mail to:
Address: ______________________________ Wallingford Farm
City: ______________________________ 21 York Street
State: ______________________________ Kennebunk, ME 04043
Zip Code: ______________________________
Fax to:
207-985-1618
Phone Number: ______________________________
Order by Phone:
207-985-2112
ORDER
Item # Product Description Quantity Price Each Total
__________ _________________________________________ _______ __________ __________
__________ _________________________________________ _______ __________ __________
__________ _________________________________________ _______ __________ __________
__________ _________________________________________ _______ __________ __________
__________ _________________________________________ _______ __________ __________
__________ _________________________________________ _______ __________ __________
__________ _________________________________________ _______ __________ __________
   
SUBTOTAL
__________
 
(add 5% sales tax in Maine only) SALES TAX
__________
   
ORDER TOTAL
__________
PAYMENT
Credit Card: __VISA   __MasterCard   __Discover
Credit Card Number: ______________________________ Expiration Date: ____________
3-digit Security Code: ______________________________      
         
Signature of Cardholder: ______________________________      
         
__Check or Money Order (make checks payable to Wallingford Farm)    
SHIPPING (FedEx Ground standard shipping in continental U.S. only. FedEx does not ship to P.O. Boxes.)
__ship order to buyer address listed above
__ship selected items to alternate address
Gift:  Y/N    
Item #(s):
______________________________      
Ship to Name:
___________________________________________________ Phone:__________
Ship to Address:
___________________________________________________    
City:
______________________________ State:____________ Zip:____________
Gift Message:
___________________________________________________  
  ___________________________________________________  
__ship selected items to another alternate address
Gift:  Y/N    
Item #(s):
______________________________      
Ship to Name:
___________________________________________________ Phone:__________
Ship to Address:
___________________________________________________    
City:
______________________________ State:____________ Zip:____________
Gift Message:
___________________________________________________  
  ___________________________________________________  

Print and complete this form and mail, fax, or call to place your order.

Wallingford Farm, 21 York St., Kennebunk, ME 04043
207-985-2112 fax 207-985-1618
2008- Wallingford Farm