Miller Hatcheries Email Order Form

This form is a text form that you can fill out with your computer. Here's how to do it: (1) Open the file – it will automatically open in Microsoft Word (2) Fill it out (3) Save the Order to your computer (remember where you file it) (4) Attach the order to the email you are sending to Miller Hatcheries at millerh@telusplanet.net.

Date		Contact Name
Company			Phone
Mailing Address	Postal Code:   Date Required:
Shipping Instructions
Call at Hatchery Trucking Company Air Cargo Air Mail
Message				Phone:
Products - Link to Price List

Quantity	Breed or Description	Sex	Price	Amount
Sub-Total
Special Services - Maximum of 10 Brooding days. We cannot ship medications - immunization occurs on site.

Quantity	Service	Price Per Chick/per Day	Brooding Days	Amount
Sub-Total

Total Charges and Payment Information	Freight or Parcel Post Charges
GST applies to Postal charges, supplies & services only	GST
If breed is not available, my second choice is:	Total Amount
Have you order Champion Chicks or Poults before? Yes No  Year?	Deposit - Amount Paid
Method of Payment:   Visa  MasterCard  Cheque Cash	Balance to Pay