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. We recommend you write "call for number" in the credit card box. 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		$
			Quantity Discount (see schedule below)		$
			8% Sales Tax (NY Residents)		$
			Subtotal		$
			Shipping		$
			TOTAL DUE		$
Security Check: This is required to insure response is generated by a human. Please enter the numbers from the image above:

Discount Schedule
Over $100	10%
Over $250	12%
Over $500	15%
Over $1,000	20%
Over $2,000	30%
Discounts applicable to hybrid plants only. No discounts on species or specials.

Last Updated: 12/29/2008

�2008 Bloomfield Orchids