Name	Shipping Date
Address	E-mail
Address	Area Code
City	Phone Number
State/Country	UPS or Postal
Zip	Work Phone

Please fill in and print out this form and send it with payment to the address above.
Thanks

QUANTITY	CULTIVAR	PRICE	TOTAL	SUBSTITUTE
Quantity			Total	Yes/No
Quantity			Total	Yes/No
Quantity			Total	Yes/No
Quantity			Total	Yes/No
Quantity			Total	Yes/No
Quantity			Total	Yes/No
Quantity			Total	Yes/No

UPS or Priority Mail:
$10.00. 1-2 plants
$0.75 each additional plant

May we substitute

Check Number			SUBTOTAL
List your choice of substitute plants:
			SHIPPING
			GRAND TOTAL