Print-Out Form (Control-P)

Buy Direct Directory Registration

Products(s) (optional) Availability -- which months?
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
Product Location (state, province, country): _________________________
Link to (email, website): ____________________________________
Amount Due:
___ Number of Proucts x $25 = _______ 
Contact Email ______________________
(required for receipt and listing confirmation)
Contact Name ____________________
Payment:
___ Credit Card (email invoice will be posted through PayPal)
___ Check or Money Order (payable to Farmer's Market Online) 
___ PayPal Invoice (email invoice will be posted)
Name _____________________________________________
Address ___________________________________________
City________________________  State ______ Country _____
Postal Code ____________________________
Phone _________________________________
Fax ___________________________________
FARMER'S MARKET ONLINE
Box 1003
Sun Valley, ID 83353
manager@FarmersMarketOnline.com
http://www.FarmersMarketOnline.com

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