2012 LADYBUG DAYLILIES - ORDER FORM

NAME ____________________________________________

SHIP ADDRESS ___________________________________

CITY ______________________________ STATE ________

PHONE# ____________________  ZIP _ _ _ _ _ - _ _ _ _

MAY WE SUB: (Check one) [  ]YES [  ]NO

Charge my CREDIT CARD:
VISA  or MC
(circle one)

Card # _____________________________

EXP. Date ____/____ Security# __ __ __

Signature: _________________________

approximate ship date: ______________

Mail this form to: DAN HANSEN
1852 E. SR46
GENEVA, FL  32732

phone #

407 349 0271

  SHIPPING:       NUMBER OF PLANTS
1 DAY UPS $30 + ($2 X _____) = _____
2 DAY UPS $20 + ($1 X _____) = _____
REG. UPS $ 10  + (.50 X _____) = _____
PR. MAIL $12 + (.75 X _____) = _____
/ # CULTIVAR (SUB OR BONUS) PRICE TOTAL
ABSOLUTE MINIMUM Order to ship $35.00 in plants
Please use back for large orders
BONUS PLANT VALUE at LEAST: __________________ (25%)
No BONUS on BARGAIN BASEMENT SPECIALS (price ends in a 9)
No Bonus of 2012 HANSEN  Introductions
FLORIDA DELIVERY and ALL garden pick-ups, add 7% SALES TAX

Total for plants above: ____________
Total for plants on back: ____________
Total plant purchase: ____________
Total shipping charges: ____________
Grand Total: ____________