THE LILY FARM ORDER FORM -
Fill out, print, & mail!
NAME
ADDRESS
CITY/STATE/ZIP
TELEPHONE
EMAIL
QUANT
NAME
PRICE
SUBT
TOTAL
METHOD OF PAYMENT
SELECT FROM LIST
Visa
MasterCard
Check
Credit Card#
Exp.
MONTH
Jan
Feb
March
April
May
June
July
Aug
Sept
Oct
Nov
Dec
YEAR
2010
2011
2012
2013
2014
2015
2016
2017
Signature: _________________________________________
Subtotal
Tx Residents 6.25% Tax
Shipping & Handling (see below)
Please Remit Total
Desired Shipping Date:
SHIPPING INFORMATION:
USPS - $12 for 3 or less plants. $12 plus $1 per plant for orders larger than 3 plants.