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Edelweiss Perennials
ORDER
FORM
29800
S. Barlow Rd.
Canby, OR 97013
Voice and fax: (503) 263-4680
E-mail: balts@canby.com
______________________________________________________________________
Name:
__________________________________________________________________
Shipping Address:
________________________________________________________
City: ___________________________________________ State: ____ Zip:
__________
Phone (Day): _______________
(Evening): _________________ Fax: _____________
E-mail: ___________________
Mailing/Billing Address (if different): _______________________________________________
Preferred shipping date:
___________ Requested pick-up date: ____________
If an item is sold out, would you prefer: [_] Substitute
[_] Credit [_] Refund
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Plant
name
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Price
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Total
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Subtotal
this page
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Subtotal
extra page
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Subtotal
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Shipping
and handling
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Total
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(See
credit card and shipping information on 2nd page)
Important: Card holder address needs to match with mailing/billing
address.
Master
Card __ Visa __ Discover___ Am. Expr.
#_____________________________
Exp. Date :______
Card holder signature__________________________________
Shipping and Handling: We ship primarily US
Priority Mail. Please contact us for other services.
Region I - CA, ID, MT, OR, WA:
$6.00 + $0.75 per plant
Region II - AZ, CO, NM, MT, UT, WY: $8.00 + $1.25 per plant
Region III - All other states: $9.00 + $2.00 per plant
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