Fill in the following information.
Please print this form and mail it with your check, money order or M/C or Visa Number to:
Lorna Rhodes-APA Secretary-Treasurer
133 Millville Street... Mendon, MA 01756
Item Name
Quantity
Price
Enclosed please find my Check
or Money Order
Subtotal
My
MasterCard/Visa Number
Shipping
Total
Credit Card Expiration Date
**
*
*
*
Please sign here:
Please ship my
order to the address below
Name
Address
City
State
Zip
Phone
Email
Thank you for shopping with the American
Poultry Association.!
