Miller Hatcheries Order Form

Miller Hatcheries - Order Form

This order form is not to be sent electronically. Please complete the form using your computer, then print and fax to Miller Hatcheries Fax - [780]479-1113 or to your Agent.

Today's Date	Shipping Instructions
Name	Call at Hatchery Trucking Company	Air Cargo Mail
Mailing Address
Phone	Date Required

To obtain prices - click to view Current Prices or click on the product links below. If you have difficulty with this form - go to Order Form 2 to complete.

Quantity	Breed or Description	Sex	Price	Amount
Chickens




Turkeys-Ducks-Geese
		Mix
		Mix
		Mix
Special Services




Start and Keep your Birds Healthy		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 ordered Champion Chicks or Poults Before? Yes No		Year?	Deposit - Amount Paid
Method of Payment Visa Cheque Cash			Balance to Pay