Licklog Farms Mail Order Form
Name:
Mailing Address:
Shipping Address: 2 Shipping Address : 3 Shipping Address:
City: City: City:
St: St: St:
Zip: Zip: Zip:
Email Address: Phone: Cell Phone:
Delivery Date: 22 inch decorated Wreaths: Quantity Each Wreath is $34.95
Payment Method: Visa MasterCard Check
If you are using a credit card, we will contact you upon receiving this form to finalize payment.
All payments are due upon order placement. Visa, MasterCard, Certified Cashiers Check, personal check, or Money orders accepted.
Is the wreath a gift? Yes No
Wording of the gift card
Merry Christmas From
Matthew 1:23
Luke 1:10-12
The Meaning of the Christmas Wreath by Holley Gerth
Your own words
Orders will be shipped to you on date specified Please remit to:
Licklog Farms
PO Box 1174
897 Licklog Rd
Newland NC 28657
Please submit this form or print off this order form and mail to address listed above.
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