Bill to:Name_____________________________________________________________Address:___________________________________________________________City/State_______________________________Zip:________________________Phone ___________________ E-mail________________________________Ship to: (If Different than above):Name______________________________________________________________Address:___________________________________________________________City/State_______________________________Zip:________________________Phone ___________________ E-mail________________________________ |
Make checks or money order payable to Fieldstone Farm of Rindge. Complete the form - don't forget to add shipping. Rates are based on USPS boxes, and are listed at the bottom right. Mail form check or money order to:Fieldstone Farm
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| Qty | Description | Price | Weight | Shipping Our shipping charge includes USPS Priority mail shipping anywhere in the continental 48 US states. Call or email for a shipping quote elsewhere. Shipping Charge:We ship via USPS. Orders Up to 6 lbs- $16.00 Orders Up to 12 lbs- $21.00 Orders Up to 24 lbs- $34.00 Orders Up to 36 lbs- $50.00 Orders over 36lbs - Call or email us for a quote.
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| _____ | Half Gallon "A" Golden Delicate Taste | $40.00 | 6 | |
| _____ | Half Gallon "A" Amber Rich Taste | $40.00 | 6 | |
| _____ | Half Gallon "A" Dark Robust Taste |
$40.00 | 6 | |
| _____ | Quart "A" Golden Delicate Taste | $22.00 | 3 | |
| _____ | Quart "A" Amber Rich Taste | $22.00 | 3 | |
| _____ | Quart "A" Dark Robust Taste | $22.00 | 3 | |
| _____ | Pint "A" Golden Delicate Taste | $13.00 | 2 | |
| _____ | Pint "A" Amber Rich Taste | $13.00 | 2 | |
| _____ | Pint "A" Dark Robust Taste | $13.00 | 2 | |
| _____ | Half Pint "A" Golden Delicate Taste | $8.00 | 1 | |
| _____ | Half Pint "A" Amber Rich Taste | $8.00 | 1 | |
| _____ | Half Pint "A" Dark Robust Taste | $8.00 | 1 | |
| _____ | 250ml Maple Leaf | $15.00 | 2 | |
| Subtotal: | ________ | _______ | ||
| Shipping(Rates to the left): | ________ | |||
Grand Total: |
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