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Customer Name: ________________________
Your Name: ____________________________
Customer #: ____________________________
Daytime Phone: (_____)___________________
Total # of Pages: _____ Date: ______________

204 Regas Road
Madison, WI 53714
Phone: 1-800-236-5880
Fax: 1-888-632-3276
Local Phone:  1-608-241-2667
Local Fax:  1-608-241-0688
www.northfarm.com
Because of the increase in late orders and their subsequent effect on other (on-time) orders, North Farm will charge $25 for all late orders (orders coming in after published deadlines).  Member accounts habitually sending late orders will be reviewed for possible termination of services.

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Toll-Free Fax: 1-888-632-3276  
Local Fax: 1-608-241-0688

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