PLEASE PRINT THIS ORDER FORM, COMPLETE, AND MAIL OR FAX
Rollingwood Garden, 21234 Rollingwood Tr., Eustis, FL 32736 -- (352) 589-8765 | FAX (352) 589-8632
Name
Address
City
State
Zip
Phone
Email
UPS Directions
Shipping Date
Please Check One:
UPS Net Day
| UPS 2nd Day Air
|
USPS Priority Mail
May We Subsitute?
Yes
No
click here for shipping charges
Please list your choice of Bonus plants on a separate sheet.
METHOD OF PAYMENT
Check Enclosed
Charge My Credit Card
Visa
Mastercard
Discover -- Expiration
Card Number:
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Signature: ___________________________________________
QTY
CULTIVAR
PRICE
QTY
CULTIVAR
PRICE
1
.
.
.
.
12
.
.
.
.
2
.
.
.
.
13
.
.
.
.
3
.
.
.
.
14
.
.
.
.
4
.
.
.
.
15
.
.
.
.
5
.
.
.
.
16
.
.
.
.
6
.
.
.
.
17
.
.
.
.
7
.
.
.
.
18
.
.
.
.
8
.
.
.
.
19
.
.
.
.
9
.
.
.
.
20
.
.
.
.
10
.
.
.
.
21
.
.
.
.
11
.
.
.
..
.
.
.
.
22
.
.
.
.
.
.
.
.
Gift Certificate Amount
.
Sub-Total
.
Postage
7% sales tax for FL residents
.
minimum order $25.00
TOTAL
.