Chicken Pre-Order Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank-you for your interest in purchasing pastured chicken from our family farm. Our chickens free range on pasture everyday, providing a quality of life (and meat) that is unmatched in the poultry industry. A varied diet of bugs, seeds, grasses and certified organic grains, combined with the act of foraging results in meat that is lean and rich in flavor. We raise a limited number of birds each year. Pre-ordering helps us determine just how many chickens to raise in a season. You also receive 10% off by ordering in advance.

After you fill out this order request, we will contact you to go over details, availability and to finalize payment to complete your pre-order. Deposits paid for pastured chicken are non-refundable. If we cannot fill your order due to unforeseen circumstances, we will issue a full refund. The remaining balance is due at the time you receive your order. Per pound prices below.

$10 Deposit due for Whole Bird and Select Cuts of Breasts
$5 Deposit due for Select Cuts of Thighs, Wings and Drums

For information on current stock, bulk orders and pricing, please contact us at (608) 520-0067 or madurbangourmet@gmail.com

Email *

Your First and Last name: *

Phone number *

Address:

Preferred contact method *

Phone

Required

Do you want Whole Bird(s) or Select Cut(s)?

Whole Bird @ $6.99/lb or $25 (the lesser of the two)

Select Cut(s) - see prices below

If pre-ordering Whole Bird, how many?

If pre-ordering Select Cuts, tell us what you want?

Breasts (2/pk) - $12.99/lb

Thighs (2/pk) - $10.99/lb

Wings (4/pk) - $4.99/lb

Drums (4/pk) - $4.99/lb

A Variety

Other:

If pre-ordering Select Cuts, what is the total number you want? For example, Mary wants to order one package of breasts, two packages of thighs and two packages of wings - for a total of 5 packages.

Please provide the details of your Select Cuts pre-order below:

How would you like to receive your goods? *

Curb-side pick-up at the farm

Westside Community Farmers Market

With my CSA delivery

Other:

Required

When would you like to receive your order? *

As soon as product becomes available

At a future date

Required

How would you like to pay? Pre-ordering requires a deposit (of $5-$10 per select cut or bird), with the remaining balance due when you receive your order. *

Mail a Check

Venmo

Credit Card (add 4% processing fee)

Required

Questions and comments

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms