Home Order Form Fax to 813.354.2761
Customer Information
Company Name ________________________________________________________
Your Name ____________________________________________________________
Address _______________________________________________________________
Address 2 ______________________________________________________________
City ___________________ State _____________ Zip ________________________
Email __________________________________________________________________
Phone ___________________________ Fax _________________________________
Cell Phone ____________________________ Best way to reach you ______________
How will the order be delivered _____________________________________________
Payment Method ________________________________________________________
Plant Order
Plant Name __________________________| Plant Name ________________________
Size Ordered _________________________| Size Ordered ________________________
Quantity Ordered ______________________|Quantity Ordered ____________________
Plant Name __________________________| Plant Name ________________________
Size Ordered _________________________| Size Ordered ________________________
Quantity Ordered ______________________|Quantity Ordered ____________________
Plant Name __________________________| Plant Name ________________________
Size Ordered _________________________| Size Ordered ________________________
Quantity Ordered ______________________|Quantity Ordered ____________________
Plant Name __________________________| Plant Name ________________________
Size Ordered _________________________| Size Ordered ________________________
Quantity Ordered ______________________|Quantity Ordered ____________________
Plant Name __________________________| Plant Name ________________________
Size Ordered _________________________| Size Ordered ________________________
Quantity Ordered ______________________|Quantity Ordered ____________________
Plant Name __________________________| Plant Name ________________________
Size Ordered _________________________| Size Ordered ________________________
Quantity Ordered ______________________|Quantity Ordered ____________________
We will total your order and email a confirmation to you with the approximate date of shipment.
Contact us: markjordn@aol.com