NAME
EMAIL
ADDRESS
CITY
STATE
ZIP
PHONE
FAX
CREDIT CARD #
*FOR FAX ONLY*



Style A
Style B
Style C
Style D
Style E
Pots
Size Style Quantity
(e.g.)4" 11B 3
Prints
Print name or item # Quantity
OTHER COMMENTS
      Call or Fax for Special Orders
Pots....
Special color?
Specific flower?
Prints...
Other Houses?
Shipping/Handling costs will be faxed or Emailed to you upon receiving your order
Indiana Residents add 6% Sales tax
Call or Fax orders with Credit Card No.'s: (812) 379.2519 *51
E-Mail

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