BERKSHIRE SWEET GOLD MAPLE & MARINE
                                                         21 ROWE ROAD, Heath 
                                              for U.S. Mail:  CHARLEMONT, MA 01339
                    PHONE/FAX 888-576-2753 (57-MAPLE), BSGFARM@PEOPLEPC.COM

ORDER DATE: _______________________
Preferred Bottle Styles          Preferred Colors             Quantity                      Price Total

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Farmkid Art greeting Card  ($1/card)   (included with baskets)                                           _________________________________
                                                                                                            
                                                                                                               SUB-TOTAL ______________________
                                                                                      
                                                                                       DELIVERY CHARGES  ________________________
                                                                                         (Click the link above to view prices ) 
                                                                                                                           TOTAL ______________________
 BILL ORDER TO:
                                                                   
Name: ________________________________________________________________________

Address:______________________________________________________________________

City, State, Zip:  ________________________________________________________________

Phone Number:  _______________________      Email (optional) ___________________________ 

SHIP ORDER TO: (If different)

 Name: ________________________________________________________________________
Address: ______________________________________________________________________

City, State, Zip: _________________________________________________________________

Gift Card Message: ______________________________________________________________


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Methods of Payment

____Visa or Mastercard        ____Check Enclosed       ____ Will Call with Credit Card Number

 Card#_____________/______________/_____________/______________

Expiration Date ( month & year ): ____/_____Signature ( as shown on card ):_____________________

(For our use only:  Batch#________________/Ref#________________/Auth#_________________)

Please call Brooks or Janis at the farmhouse with questions or comments and THANK YOU for supporting family-scale agroforestry!

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