MileAway Farm Christmas Wreaths Order Form
(print this form and then fax to us at 207-342-2003)

Contact Information

Name: ____________________________________________________
Address 1: ____________________________________________________
Address 2: ____________________________________________________
City: ___________________________________ State: __________
Zip Code: _____________
Daytime Phone: ____________________________________________________
Evening Phone: ____________________________________________________
Email: ____________________________________________________

Payment Information (Leave blank if you would prefer we call you )

Type of Card (circle one): Mastercard  Visa American Express  Discover
Cardholder Name: __________________________________________________
Cardholder Number: __________________________________________________
Expiration Date: _____/_______  (mm/yyyy)

Order Information

Quantity

Description

Price

Total Price

 

24 Inch Diameter Christmas Wreath

$25.95 + Shipping

 

 

26 Inch Diameter Christmas Wreath

$39.95*

 

 

28 Inch Diameter Christmas Wreath

$44.95*

 

 

30 Inch Diameter Christmas Wreath

$54.95*

 

 

Centerpiece

$29.95*

 

 

Garland (9 foot)

$31.95*

 

 

8 1/2" Balsam Fir Pillow

$16.95*

 

 

Grand Total

 

 

*Please add $2 for shipments west of the Mississippi.

Ship To Information

Order #1

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________
From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________ 

Order #2

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________
From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________ 

Order #3

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________
From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________ 

Order #4

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________
From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________ 

Order #5

Item Ordered:

____________________________________________________

Greeting

 

To:_________________________________________________
From:_______________________________________________

 

Name:

____________________________________________________

Address 1:

____________________________________________________

Address 2:

____________________________________________________

City:

___________________________________ State: _________

Zip Code:

________________