and Culinaries™
237 Bakers Branch Rd. Louisa, VA 23093
Date: ______Member# ______Please print all information.Name: ______
Address: ______
Town: ______State:______Zip: ______
If your address has changed please write old zip code: ______
q Check if "ship to" address differs from above and write in space below.
Have you ordered from us before? q Yes q No / Office use: 2000
May we substitute a similar variety if sold out? q Yes q No / L/CR L/BD
Feel free to write substitution instructions in order form comment section. / CM Chk
q Check if you need a new order form sent with your order.
Payment method: / BD
qVisa qMasterCard qDiscover qCheck______qMoney Order______qCredit/GC______/ Pd / B/O
Credit card number: |___|___|___|___| |___|___|___|___| |___|___|___|___| |___|___|___|___|
Card expires: |___|___| |___|___| Cardholder's name: ______/ NInv SEAS BULB ROOT SEAS
Daytime telephone number: ( ______) ______ Fax: ( ______) ______
E-mail address: ______Are you a market grower? q Yes q No / Picked: Checked:
CATALOG
NUMBER / PACKAGE
SIZE / HOW
MANY / TYPE OF PLANT NAME OF VARIETY OR ITEM
(Please fill in all columns completely) / PRICE / Office use
Subtotal this side
Subtotal from other side (including additional pages)MERCHANDISE SUBTOTAL
Credit from previous order or gift certificate (Please enclose.)
ORDER SUBTOTAL
VIRGINIA RESIDENTS ONLY: Add 5.3% VA sales tax.
STANDARD DELIVERY CHARGE: See table at left.
TELEPHONE ORDERS UNDER $40: If applicable, see table at left.
CANADA: If seeds only, add $2.50, otherwise double shipping.
Please see other side. / TOTAL AMOUNT OF ORDER
Please keep a dated copy of your order. Telephone: (540) 872-8351 Fax: (540) 894-9481 Thank you!