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Use this form if you would like to order chicken or just ask us a question.

Please provide the following contact information:

First Name
Last Name
Home Phone
E-mail

Please provide the following ordering information:

CODE PRODUCT DESCRIPTION &  (box/case)

Enter the order date:

-- dd/mm/yy

Any comments, questions, or suggestions?



Copyright 2004 [Jeremy Prinzen]. All rights reserved.
Revised: 06/19/06