Vermont Ladyslipper Company, Ltd.
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INTERNATIONAL CYPRIPEDIUM ORDER 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      International Money Order/Bank Certified Funds      Wire Transfer      MasterCard*      Visa*
         
Card Expiration Date MONTH          YEAR          
Credit Card Number                                                                                
Signature                                                                  
 
QUANTITY minimum order is 5 plantsPLANT/SPECIES DESCRIPTIONPRICE each TOTAL
       
       
       
SUBTOTAL
 
EUROPEAN UNION COUNTRIES For additional CITES documents and Phyto-Sanitary Inspection
For orders totalling less than $1250.00 US ADD $58.00
for orders totalling more than $1250.00 US ADD $75.00
 
ALL OTHER COUNTRIESFor Phyto-Sanitary Inspection
For orders totalling less than $1250.00 US ADD $23.00
for orders totalling more than $1250.00 US ADD $50.00
 
SHIPPING & HANDLING CHARGE
Contact us for Shipping & Handling Charge For your Specific Order and Country
 
 
GRAND TOTAL U.S. Funds
 
Make International Money Order/Bank Treasurer's Check payable to: Vermont Ladyslipper Company. Remit to:
Vermont Ladyslipper Company, 56 Leduc Road, New Haven, VT 05472-1000
.
For wire transfer payment instructions please contact us.

THANK YOU FOR YOUR PATRONAGE !

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