Page Title

Vermont Wildflower Farm

Order Form

Acceptable Forms of Payment:
Checks/Money Order (US$), Visa, Mastercard, American Express and Discover

BILL TO:

Street Address:

City State, Zip Code

Phone ( ) _______________-________________
Only to be used to contact you about your order!

Please make checks payable to: Vermont Wildflower Farm
Mail Orders with payment to: PO Box 96, Charlotte, Vermont 05445
Phone Orders: (802) 425-3641 Fax Orders: (802) 425-3642
Email: vermontwildflowerfarm@yahoo.com
Website: www.vermontwildflowerfarm.com

Payment: Check__ VS__MC__Amex__Discover__Credit Card# ______________________________________________________

Expiration Date_______________ CVV#________ Signature (Required) _______________________________________________________
Note: CVV# is the last 3 digits on back of card - For Amex 4 digits on front of card

Sub Total
Shipping
Total

Size	Quantity	Description	Unit Price	Total

SHIP TO:

Street Address:

City, State, Zip Code

Yes, we ship to PO Boxes by US Priority Mail

Comments: (Use this space to let us know any special instructions)
If this is a gift order, we offer free gift cards! Let us know your message here!

Send me an e-mail confirmation when my order ships!

Email: ______________________________________________

Click here for Current Specials!

SHIP MY ORDER TO ME:

_____ NOW ____SPRING ____FALL ________OTHER
(Please specify date)

SHIPPING CHARGES
(For the U.S. Only)

      Up to $19.99............................$ 5.95
$20.00 - $29.99........................... $ 7.95
$30.00 - $59.99........................... $ 9.95
$60.00 - $84.99........................... $11.95
$85.00 - $99.99........................... $13.95
$100.00 - $299.99......................... $16.95
   Over $300.00............................ FREE
  5lbs. + Seed.............................. FREE

For Express Shipping or International orders, please
contact us!