Please provide the following contact/billing information (*Required Fields):

*Name (Same as on credit card please!)
Organization
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Country
*Daytime Phone
FAX
*E-mail (for order confirmation)

Please provide the following ordering information for your Sticky Machine^TM and Accessories:

QTY	DESCRIPTION		PRICE
	Sticky Machine (Skin Color = Yellow)		$2759.00
ORDER THESE CUSTOM OPTIONS (REQUIRES ADDITIONAL DELIVERY TIME):
	Custom Skin Color	Red White Green Blue	$80.00
	Labeler		Coming spring 2003!
	Counter (click to see)	Installed & tested	$150.00
	Canvas Cover		$125.00
	Wheels (Set of two)		$55.00
	Handles (Each)		$28.00
	Cardboard Display Boxes for straws  (each holds 250 straws)		1-5 boxes: $1.25 per box 5-10 boxes: $0.75 per box > 10 boxes: $0.60 per box
Shipping and handling in U.S. only (ground) See a shipping crate (click here) (Contact Busy Bee Farm for shipping to other locations)			$150.00 (Approx)

 

	BILLING
Credit Card	VISA MasterCard
Cardholder Name
Card Number
Expiration Date
Certified Check	Make check payable to: Busy Bee Farm, LLC 220 Pinehurst Dr. E. Longmeadow,  Mass.  01028

 

* Required Fields	SHIPPING INFORMATION
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Country

Do you want to be added to a honey producers' database?	Yes No
Do you want to be added to a Sticky MachineTM locator list?	Yes No

Enter any special instructions in the space provided below.