"Farmer To Farmer" DVD Order Form (On-Line)

 

Name:  

Phone #:  

Email Address:  

 

Address:  

City/Town:  

Province:  

Postal Code: 

 

Quantity:      X  $6.00 (taxes included)  = Total Amount to be Mailed in  $

 

Mailing Address:

Manitoba Farmer With Disabilities

Box 367, 128 Gladys Street

Elm Creek

MB, R0G 0N0

 

Phone: (204) 436-3181

Fax: (204) 436-3385

 

         

       

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