PRINT OUT this form and use it to mail your order directly to:

Refuge Farms, Inc. 2005 Open Barn Necklace P.O. Box 195 Spring Valley, WI 54767

[PLEASE PRINT]

Order Date:
Name:
Street Address(1):
Address(2):
City:
State:
Zip Code:
Telephone Number:
Email Address:

Order Description	Quantity	x	Cost	=	Sub Total
2.4mm 20 inch sterling silver chain and horse charm		x	$25.00	=	$
Shipping & Handling (included) [continental US only]					$0.00
DO NOT SEND CASH - Check or Money Order only. TOTAL ENCLOSED					$

*** Please allow 1 week for delivery of merchandise ***

Thank you for your order!