JEFFCOAT FARMS

1205 CR 226, Gatesville Tx 76528

(254) 494-0585

 

MERCHANDISE ORDER FORM

Print This Form & Include Payment With Order Form.
Incomplete Order Forms or Orders Without Payment Will Not Be Processed

NAME _______________________________________ PHONE # ______________________

ADDRESS-1 _______________________________________ FAX # _____________________

ADDRESS-2 _______________________________________ E-MAIL ____________________

CITY, ST, ZIP __________________________________________________________________

|_ ITEM # _|__ DESCRIPTION __| QTY |_ PRICE _|__ TOTAL __|

|__________|___________________|______|_________|____________|
|__________|___________________|______|_________|____________|
|__________|___________________|______|_________|____________|
|__________|___________________|______|_________|____________|
|__________|___________________|______|_________|____________|
|__________|___________________|______|_________|____________|
|__________|___________________|______|_________|____________|
|__________|___________________|______|_________|____________|
|__________|___________________|______|_________|____________|
|__________|___________________|______|_________|____________|

ORDER SUB-TOTAL : ______________
INCLUDE S/H : ____________
TOTAL OF ORDER : ______________

PLEASE ALLOW 2-6 WEEKS FOR DELIVERY * * * THANK YOU FOR YOUR ORDER
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