Lilac Order Form

 

Billing Name & Address (Please Print)                                                      Shipping Name & Address (If different from billing)

 

Name:                                                                                                  Name:

 

Address:                                                                                            Address:

 

 

City:                                                                                                    City:

 

State:                            Zip:                                                                 State:                             Zip:

 

Contact numbers: (If we have questions about your order)                                                                                                    

 

Home: (        )                                        Work: (        )                                         Email:

 

Substitutions: We can substitute a similar lilac with the same color if you wish.          

 

Choose substitutions for me                                          Use my substitutions list

 

Back order if unavailable                                               Refund my money/no substitutions

 

 

Please Ship the following lilacs

Qty

Size

 Name & Code # of Lilac

Unit Price

Item Total

 

 

 

 

$

 

 

 

 

$

 

 

 

 

$

 

 

 

 

$

 

 

 

 

$

 

 

 

 

$

 

 

 

 

$

 

 

 

 

$

 

 

 

 

$

 

 

 

 

$

         

                                                                                                                                                                      Lilac Total

 

$

$7.00 Base Charge plus $1.00 for each Lilac Shipped                                                       

Shipping

 

 

$

 

                                                                                                                                                                      Subtotal

 

$

                                                                                                                              

                                                                                                       Maine Residents Add 5% Sales Tax

 

$

                                                                                                                                                                     

                                                                                                                                                                   Grand Total

 

$

 

Visa    Master Card    Discover    American Express    Check

 

Card Number: ____ ____  ____  ____ / ____  ____  ____  ____ / ____  ____  ____  ____ /____  ____  ____  ____

 

Expiration Date: ____  ____ /____ ____ / ____ ____

 

Signature: ____________________________________________________________________

 

Thank You!