Vermont Ladyslipper Company, Ltd.

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USA CYPRIPEDIUM ORDER FORM
Printable Only Form

NAME                                                                 
SHIPPING 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                                                                                

Signature                                                                  
 
QUANTITY minimum order is 2 plantsPLANT/SPECIES DESCRIPTIONPRICE each TOTAL
       
       
       
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
2 Plants $20.50
3-6 Plants $24.25
7-10 Plants $40.45
11-19 Plants $54.40
20-30 Plants $75.40
Over 30 Plants or Delivery to 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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