Business Name:________________________________________________________________________________
(if shipping to commercial address)

Purchaser Name:_______________________________________________________________________________

Address (Nbr / Street):_______________________________________________________________________

City:______________________________________________

Province/Region:__________________________________________

Country: _________________________________________________

E-Mail Address: ________________________________________________________

Tel Nbr: ______________________________ Fax Nbr: ______________________________

Payment Method: ______ Visa            ______ MasterCard

Card Nbr:___________/___________/___________/___________

Card Expiration Date: _______/_______
                                        MO              YR

__________________________________________________________________________________
Name as it appears on card (please print)

__________________________________________________________________________________
Signature of card holder (required)

SHIPPING SCHEDULE: Please select or we will schedule for next available date:
______ April 2001        ______ May 2001        ______ June 2001        ______ July 2001

Does your country require a Plant Import Permit? (not applicable in Canada)
______ YES        ______Permit included with order        Will send permit by (date) __________

______ NO - PERMIT NOT REQUIRED

Please print and list plants on next page.