Vermont Ladyslipper Company, Ltd.

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USA CYPRIPEDIUM GIFT ORDER FORM
Printable Only Form

GIFT RECIPIENT'S INFORMATION
GIFT RECIPIENT NAME                                                                 
GIFT RECIPIENT MAILING ADDRESS                                                                  
                                                                  
E-MAIL ADDRESS                                                                  
TELEPHONE NUMBER with area code                                                                  


YOUR INFORMATION
YOUR NAME                                                                 
YOUR MAILING ADDRESS                                                                  
                                                                  
E-MAIL ADDRESS                                                                  
TELEPHONE NUMBER with area code                                                                  

MasterCard®
* Visa & MasterCard accepted for orders up to $500.00 US
Payment Method Check One      Check or Money Order enclosed      MasterCard*      Visa*
         
Card Expiration Date MONTH          YEAR          
Credit Card Number                                                                                
Name on Card                                                                  
Signature                                                                  


ORDER DETAILS  
QUANTITY minimum order is 2 plantsPLANT/SPECIES DESCRIPTIONPRICE each TOTAL
       
       
       
GIFT CARD ($2.50 ea.)
 
SUBTOTAL
 
Delivery in/to VT ADD 6% VT Sales Tax
 
SHIPPING & HANDLING CHARGE
See Shipping and Handling Charge Schedule Below
 
 
GRAND TOTAL U.S. Funds
 
SCHEDULE OF SHIPPING AND HANDLING CHARGES
# OF PLANTS ORDEREDYOUR SHIPPING & HANDLING COST- Effective 09/02/05
2 Plants $18.50
3-6 Plants $23.25
7-10 Plants $39.45
11-19 Plants $53.40
20-30 Plants $74.40
Over 30 Plants or Delivery to CA,OR,WA,AK Please contact us for Shipping & Handling Charge
Make check or Money Order payable to: Vermont Ladyslipper Company. Please remit to:
Vermont Ladyslipper Company, 56 Leduc Road, New Haven, VT 05472-1000

THANK YOU FOR YOUR PATRONAGE !

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