Order Form:  Pastured Chicken

Amount ordered ($2.95 p/lb): Whole__________ Whole (cut up, add $2) __________

Amount Deposited ($5.00 per bird): ___________________

Pick-up dates:                       Mutually agreed upon  

Contact Person for pork and/or chicken orders (no more than 1 per order).

Please fill out all fields.

Name: ___________________________________________

Address, State, Zip: __________________________________________________________

Telephone number: __________________________________

Email address: __________________________________

Total deposit: _______________________________

Deposits are non-refundable unless Back Creek Bend Farm is unable to fill the order.

Thank you for your Support!!!