Camilla Valley Farm Online Order Form
Billing Address
First Name*
Last Name*
Company
Country *
Canada
USA
All Other Countries
Address*
Address 2
City*
Email*
Phone*
Ship Items to the above Billing Address
Shipping Address
Item(s) will be shipped to your billing address.
First Name
Last Name
Country *
Canada
USA
All Other Countries
Address *
Address 2
City *
* Indicates Mandatory Field
* Indicates Mandatory Field
Order Items
PN#
Description
Unit Price
Quantity
Extended
$0.00
CDN
Payment Information
Payment Type*
Visa/MasterCard
Cheque
Check
eTransfer
Card Number
We accept VISA and Mastercard Credit Cards (but not AMEX, Debit Cards or Paypal)
Expiry Date
Month
Jan. (01)
Feb. (02)
March (03)
April (04)
May (05)
June (06)
July (07)
August (08)
Sept. (09)
Oct. (10)
Nov. (11)
Dec. (12)
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Security Code
Name on Card
Comments
Note that we will acknowledge your order prior to shipment using the email you provided.