Order Form

Be sure you have read the How to Order Page. You can use this form to type in your order information, then print and fax it to your Agent or to Miller Hatcheries [780] 349-6691  Use Email Order Form to send by email.

Date

Contact Name

Company Phone
Mailing Address
Postal Code: Date Required:

Shipping Instructions

Call at Hatchery Trucking Company Air Cargo Air Mail
Message Phone:

 

Products - Link to Price List

Quantity Breed or Description Sex Price Amount

Sub-Total

Special Services- Maximum of 10 Brooding days. We cannot ship medications - immunization occurs on site.

Quantity Service Price Per Chick/per Day Brooding
Days
Amount

Sub-Total

Total Charges and Payment Information

Freight or Parcel Post Charges

GST applies to Postal charges, supplies & services only

GST

If breed is not available, my second choice is:

Total Amount

Have you order Champion Chicks or Poults before?
Yes  No  Year?

Deposit - Amount Paid

Method of Payment:   Visa  MasterCard  Cheque  Cash

Balance to Pay