Form
kuipers homestead.
chicken order form.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
My Products
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next
( X )
wings
prize and quantity are per pound.
$5.00
$
5.00
Quantity
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breast.
prize and quantity are per pound.
$6.00
$
6.00
Quantity
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thighs
prize and quantity are per pound.
$5.00
$
5.00
Quantity
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drumsticks.
prize and quantity are per pound.
$4.50
$
4.50
Quantity
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whole chickens.
prize per pound min order is 3.5 pounds.
$4.00
$
4.00
Quantity
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eggs
prize for one dozen.
$3.00
$
3.00
Quantity
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Submit
Should be Empty: