Please print out and mail to us
A Farmer's Wife
608 Douglas
Las Vegas, NM  87701
phone 505-454-4526

Ordered by: Name: _____________________________ Address: ___________________________ __________________________________ City:  _________________  State: ______ Zip:  __________ Phone #_____________ E-Mail: ____________________________

Shipped to:  (If different from Ordered by) Name: _____________________________ Address: ___________________________ __________________________________ City:  _________________  State: ______ Zip:  __________

Please include a street address(or physical address) with all orders.
Payment by:
 ___Personal check ___money order ___other_______________________________