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 

(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:               $5.00 + $0.75 per plant

Region II - AZ, CO, NM, MT, UT, WY:      $6.00 + $1.00 per plant

Region III - All other states:                            $8.00 + $1.50 per plant