Miller Hatcheries Email Order Form

Here's how to complete this form and send it by email: (1) This file will open automatically in your browser (2) From your browser click on File > Send > Page by Email (3) Email will open with form in body (4) Fill in form (5) Add millerh@telusplanet.net to recipient address. You can either print the email for your records or keep it in your sent mail. If you don’t use Microsoft Outlook this may not work as described above. In that case please fax your order.

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