Box 367, 128 Gladys Street

Elm Creek, MB, R0G 0N0

Tel: (204) 436-3181

Fax: (204) 436-3385

Toll Free: 1-866-680-6393

www.mfwd.ca

  

 

 

 

"Farmer To Farmer" DVD Order Form (printable)

Name: _____________________________________________________________________             

Phone #: ___________________________

Email Address: ______________________

 

Address:  ________________________________________

City/Town: _______________________________________

Province: ________________________________________

Postal Code: ______________________________________

 

Quantity: ______  X  $6.00 (taxes included)  = Total Amount Enclosed  $___________

 

Mail Completed Order Form To:

Manitoba Farmer With Disabilities

Box 367, 128 Gladys Street

Elm Creek

MB, R0G 0N0

 

Phone: (204) 436-3181

Fax: (204) 436-3385