Vermont Wildflower Farm
Order Form
Acceptable Forms of Payment:
Checks/Money Order (US$), Visa, Mastercard, American Express and Discover
BILL TO:
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Street Address:
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City State, Zip Code
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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
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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
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Size
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Quantity
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Description
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Unit Price
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Total
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SHIP TO:
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Street Address:
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City, State, Zip Code
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Yes, we ship to PO Boxes by US Priority Mail
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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!
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Send me an e-mail confirmation when my order ships!
Email: ______________________________________________
SHIP MY ORDER TO ME:
_____ NOW ____SPRING ____FALL ________OTHER
(Please specify date)
SHIPPING CHARGES
(For the U.S. Only)
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or more!
