Kyle LeBlanc Crawfish Farms
302 St. Peter St. · Raceland, LA 70394
· Fax: 985-537-4658
ONLINE ORDER FORM
and Last Name
of Person Placing order
For Door delivery, first and last name of person to be delivered to.
For Airport delivery, first and last name of person picking
For Door delivery, enter delivery address, city, state and zip code.
For Airport delivery, enter 3 letter airport code and city,
- PLEASE READ: We email confirmation
of receipt of your order within 24 hours. Weekend orders will
receive confirmation on Monday.
If no confirmation received, call
Date to Receive
more lines are needed for your order, you can write them in comments
below, or send an email to email@example.com with additional information).
in shipping charges if you want them charged to your Fedex or UPS
account, or if
shipping to airport (you will pay airport
shipping charges upon pickup directly to the
airline). Use chart (click here) for shipping charges.
Express Account no.
WE ARE NOT RESPONSIBLE FOR ANY SERVICE FAILURE LOSS BY ANY SHIPPING COMPANY
Name exactly as
Billing City, State
Discover American Express
What is the security code? (see below)
security code is the last 3 numbers on the reverse of your card.
is the 4 small numbers printed just above your account no.
on the front of the
Comments, if any.
Once you press the submit
button, you will see a summary of your order listed; please print this
out for your record.
clicking the "SUBMIT" button, cardholder named above agrees to pay all
shipping charges associated with this order as stated in this order ,
whether the shipping is charged to your Fedex/UPS/Airline account,
charged by us or charged by the airline upon pick up. Cardholder also
agrees to pay any and all unpaid, reversed or returned charges with the
credit card number provided on this order form.