SURRENCY DAYLILIES
Deloris & L.A. Surrency
290 Surrency Place, Screven, GA 31560
(912) 579-2353 | dsurrency@hotmail.com

Homepage	Order Form	E-Mail
Pricelist A-E	Pricelist F-R	Pricelist S-Z

PLEASE PRINT THIS ORDER FORM, COMPLETE, AND MAIL

Name
Address
City
State	Zip
Phone
Email
Shipping Date
We ship by U.S. Postal Service Priority Mail shipping charge is $8.00 per order plus $.50 per plant		May We Subsitute? Yes No

METHOD OF PAYMENT

Check Enclosed -- Please make checks payable to: Deloris Surrency

	QTY	CULTIVAR	PRICE				QTY	CULTIVAR	PRICE
1	.	.	.	.		12	.	.	.	.
2	.	.	.	.		13	.	.	.	.
3	.	.	.	.		14	.	.	.	.
4	.	.	.	.		15	.	.	.	.
5	.	.	.	.		16	.	.	.	.
6	.	.	.	.		17	.	.	.	.
7	.	.	.	.		18	.	.	.	.
8	.	.	.	.		19	.	.	.	.
9	.	.	.	.		20	.	.	.	.
10	.	.	.	.		21	.	.	.	.
11	..	...	..	..		22	..	..	..	..

Gift Certificate Amount	.
Sub-Total	.
$8.00 per order plus $.50 per plant           Postage
TOTAL	.