Belle Vallée Order Form

Name *

First Name

Last Name

Phone *

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Delivery *

Would you like to pick your order up at the next market or have it shipped to you?

Pick up at market

Ship it to me

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I consent to having this website store my submitted information so they can respond to my inquiry.

Yes, I consent.