Date:________________
ORDERED BY:

Name::_______________________________

Address1:______________________________

Address2:______________________________

City:__________________________________

State:___________________Zip:___________

Home Phone ___________________________

Work Phone #__________________________

E-mail:________________________________

Have you ordered from us before? ______Yes _____No

$__________Total from page 2

$__________Packing & Handling Charge
(.15 cents per plant)

Shipping charges (Please choose your carrier)

$_________UPS Ground Service

$_________UPS 2nd Day Air Service

$_________USPS Priority Mail

$_________Subtotal

$_________Pennsylvania State Sales Tax

$__________Total enclosed

Fill out only if shipped to a different address:
SHIP TO:
Name:____________________________________

Address1:_______________________________

Address 2:______________________________

City:____________________________________

State: _______________ ZiP______________

Please indicate method of payment:

____Money Order___Mastercard___Visa

For Credit Card Orders only:

Card#_________/________/________/________

Expiration Date: _________/__________

Signature:_________________________________

If we are out of varieties you have selected, should we:
_____Not Substitute
__ ____Substitute with Randy's choice
______ Substitute with one of the following:

________________________________________
________________________________________
______________________________________
(If no indication is made, we will substitute, or issue credit)

You can also Phone/Fax these forms to us at:
1-570-888-4715