JON'S HEIRLOOM PLANTS Order Form

JON'S HEIRLOOM PLANTS
PO BOX 54, MANSFIELD, MO 65704
CELL PH 870-404-4771
jonsplants@yahoo.com

To place an order, simply print out this form. Fill in the fields with a pen or pencil, then mail or fax it to us.
VISA, MasterCard, cheque and money order accepted. Cheque may be reqired to clear before shipping.

Ship to:

Street address:

PO Box #:

City:

State or Province:

Postal, Zip Code:

Telephone:

Fax:

Order Placed By:

Visa Card #:

MasterCard #:

Expiration Date:

Full Name on Card:

DATE:

Email address:

Authorized Signature:

FOR PLANT ORDERS, JUST ADD $8.95 POSTAGE! There is no limit the amount plants you can buy and still pay our low shipping charge. ,

Item #:	Quantity:	Description/Variety:	Per Unit Cost:	Total Amount:










			Sub-Total

		(FOR OFFICE USE ONLY)	2-3 Day Mail, Shipping/Handling $8.95
			Total Due

COMMENTS & SPECIAL REQUIREMENTS

Ship to:
Street address:
PO Box #:
City:
State or Province:
Postal, Zip Code:
Telephone:
Fax:
Order Placed By:
Visa Card #:
MasterCard #:
Expiration Date:
Full Name on Card:
DATE:
Email address:
Authorized Signature: