2007 ORDER FORM
PLEASE DO NOT EMAIL ORDERING INFORMATION
We do not have a secure server.  Instead...

Print this form and mail to: 
Berg's Hatchery
Box 547, Russell, MB R0J 1W0
or Fax to: 204-773-3270

Pick-Up Date: _______________________________    Pick-Up or Post: ______________________
                                                                                                                      (contact us for post charges)
Name: ______________________________________

Land Location: ___________________________________________________________________

                        ___________________________________________________________________

Mailing Address:_________________________  Town: ____________  Province: ______________

Postal Code:  ________________                 Phone #:________________
Quantity Breed Sex Price Amount
         
         
         
         
         
         
 
Total  

Method of Payment
CREDIT CARD:     VISA  ____      MASTER CARD ______   CHEQUE _____

Name on card:  _______________________________   Expiry Date: __________________

Signature: ________________________________

If you wish to pick up your order from one of our agents
please be sure to place your order and pay that agent.
List of Agents

Specialty Bird Discount

Thank you for your patronage.
Prices subject to change without notice