Name ___________________________ City __________________ State ____

1. The Nation of Islam Ministry of Agriculture NOIMOA Bulk Staple Goods Purchase Project 3 Thank you, to all who have participated in the Staple Goods Program this far, and we look forward to your continued support! We are working throughout the Ministry of Agriculture across your Nation to continually bring you a variety of products while putting into practice the pooling of our resources as we are taught by The Most Honorable Elijah Muhammad. Please see instructions below on how to place your order. Indicate the number of bags or cases you would like to purchase in the “How Many” column Calculate the total amount of your order and get a money order for that amount. Return this form along with your money order to your coordinator by Sunday, May 20, 2012 4. Your coordinator will then issue you a receipt and inform you of expected delivery date in mid –June 2012. Coordinator’s Name _______________________ E-mail _______________________Phone #________________ (Shipping included) Total ______ ______ www.noimoa.comwww.muhammadfarms.com ----------------------------------------------------------------------------------------------- T o be completed by coordinator Name ___________________________ City __________________ State ____ Phone # ___________________ E-mail Address _______________________ Total lbs _______ Cost _______ Units _______