Order Form

not for use: THIS IS A SAMPLE ONLY

F.H.W

XXXX 5th Street
Hartsville, SC
29550

Phone: 843 332-XXXX
Email: hbsass@wyliecoyote.com

Name

Ship Date

Email

Address

City/Town

State

Zip

Day Phone

Night Phone

Row
----

Loc#
-----

No. of
Plants

Cultivar Name
----------

Price $
-----

Total
-----

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sub Total

 

Please list
substitutes on back

Ground Shipping $14 + $1 per plant over 2 plants
Customers west of the state of Mississippi please add $2

 

Total