Enclose check, money order or charge number.
Your plants will be shipped at the nearest appropriate
future date for transplanting in your area.

PLEASE PRINT THE FOLLOWING INFORMATION

Date:__________________________________________________________________

Name:__________________________________________________________________

Address:________________________________________________________________

City:___________________________________________________________________

State:____________________________________     Zip:  _______________________

Phone:(_________) ______________________________________________________

Payment Type :  _ Check/M.O.  _ Master Card _ Visa _ Discover

Credit Card No:______________________________ Exp. Date:__________________

Signature:_______________________________________________________________
DO NOT USE
ITEM NUMBER
PLANT NAME
QTY
PRICE
EXTENDED PRICE
           
           
           
           
           
           
           
           
           
           
           
           
SATISFACTION GUARANTEED
 Shipping / Handling Charges
Minimum Order $35.00

Orders that are :
Up to 40                      add $ 9
$41 to 75                     add $11
$76 to 100                   add $13
Over $100                    add $16
Mail To:
Rock Island Wildflowers
P.O. Box 57
Rock Island, TN.
38581-0057

Order Sub-Total:                     $ __________

TN. Residents Add Sales Tax: $ __________

Shipping & Handling:              $ __________

Grand Total:                           $ _________
Remit with Order