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Heirloom Wheat for Communion Bread
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(mm/dd/yyyy)
Purchaser Information

First Name
Last Name

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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

If not already listed in the address, what church will receive this share?

If not the person who is paying for the share, who will be the liaison to coordinate delivery and the church's membership?

What is the phone number of the church's liaison to Plainsong Farm?

What is the email address of the church's liaison to Plainsong Farm?