Name *

First Name

Last Name

Delivery Address *

Address 1

Address 2

City

State/Province

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Country

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commercial loading dock

commercial lift gate required

residential

Please check all that apply: *

cottage bakery

production bakery

brick + mortar bakery storefront

sell at farmers market

bread subscription

retail store with bulk bins

other (please describe below)

What drives your interest in our flour..please mark all that apply

stone-ground

regionality/locality

organic

farmer/miller/baker relationship