Order Form
This is not a real form only a class project - I am not selling any plants.
First Name:
Last Name:
Address:
City:
Province:
Select a Province
BC
AB
SK
MB
ON
QC
NB
NS
PEI
NL
Postal Code:
Email:
Phone:
*Member Number:
*If you do not have a number yet leave this field blank.
Delivery Method:
FedEx
UPS
Canada Post
Credit Card Details - Do not enter an actual number!
Card Type:
Visa
MasterCard
PayPal
Credit Card Number:
Name on Credit Card:
Expiry Date:
Month
Select a Date
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
09
10
11
12
13
14
15
Plant Purchases
#E12-BP Black Prince
Small Qty
Large Qty
#E13-TT Topsy Turvy
Small Qty
Large Qty
#E14-FW The Farmer's Wife
Small Qty
Large Qty
#E15-MT Metallica
Small Qty
Large Qty
#H11-CP Haw. Pilifera
Offshoot Qty
SubTotal:
$
Shipping & Handing
Select Price
Up to 3 Plants $4
Up to 5 Plants $7
Up to 10 Plants $11
Up to 20 Plants $15
Total:
$
Additional Comments:
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