Venezia by PVII

Order Form


Name: ____________________________________________

Address: __________________________________________

City, State, zip:_____________________________________

Phone; Home: _______________ Office:_________________

Shipping date:_________ Priority Mail_________

COTTAGE GARDENS
Order Form



Money Orders & Checks also accepted

Brent Ross
4540 East Shelby Road, Medina, New York 14103
(585) 798-5441 Garden Phone
(585) 813-5982 Cell Phone
  cglilies@rochester.rr.com

QUANITY

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CULTIVAR NAME

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subtotal

shipping

New York residents add 8%

TOTAL DUE

AMOUNT

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Payment by check ______ money order_____ or credit card______
Credit card type__________________ Credit card #_________________________  Exp date____________  
security code_____  Signature_______________________________



Money Orders & Checks also accepted