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NAME...................

ADDRESS............

CITY,STATE,ZIP.

PHONE.................

FAX.......................

                                             PRICE            QT.          AMT.

1 OZ BOTTLE DOE ESTROGEN  $6.00           ______      ______

2 OZ BOTTLE DOE ESTROGEN  $8.00           ______      ______

                                                         SUBTOTAL _______

                                                    SALES TAX 6%_______

                                                  UPS DELIVERY   $5.25

                              COD CHARGE IF APPLICABLE-$6.00

                                                     TOTAL DUE $_______

JACKSON FARMS BUCK LURE, 11 South Ayers Hill Rd. COUDERSPORT, PA. 16915

PHONE:(814)274-9388    FAX:(814)274-2227

SEND ALL ORDERS TO THE ADDRESS ABOVE MONEY ORDERS OR CASHIER CHECKS ONLY ACCEPTED LURE IS AVAILABLE SEPTEMBER THROUGH HUNTING SEASON.