Bloomfield Orchids Online Order Form

This form sends an e-mail message to Bloomfield Orchids with the details of your order. This may be considered a non-secure transmission. If you prefer to fax or mail your form to us, use the printed order form.

Sold to:
First Name
Last Name
Address 1
Address 2
City
State
Zip
Country
Daytime Phone
Evening Phone
E-mail

Ship to (if different than above)
First Name
Last Name
Address 1
Address 2
City
State
Zip
Country

Payment method	Visa Master Card American Express	May we substitute size?	Yes No
Card Number		Expiration Date

QTY	CAT #	POT SIZE	DESCRIPTION	UNIT PRICE	QTY PRICE
				$	$
				$	$
				$	$
				$	$
				$	$
				$	$
				$	$
				$	$
				$	$
				$	$
				$	$
U.S. Shipping $8 for first plant, $1.75 for each additional plant. See terms for additional shipping info, including foreign shipping.			Total		$
			8% Sales Tax (NY Residents)		$
			Subtotal		$
			Shipping		$
			TOTAL DUE		$

Last Updated: 08/24/2005

�2005

Bloomfield Orchids