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
.