PLEASE DOUBLE CHECK THAT ALL OF YOUR INFORMATION IS CORRECT AND LEDGIBLE.  PLEASE PRINT.

SEND MAILER BOX TO:

NAME:  ________________________________________________________________

ADDRESS:   (Street address if shipping via UPS)

_______________________________________________________________________

CITY:  __________________________    STATE: ____________    ZIP:  ___________

ENCLOSURE CARD MESSAGE:

_______________________________________________________________________

DATE TO BE SHIPPED:  __________________________________________________

Total cost of Mailer Box plus Shipping and Handling is $23.83

Please send check or use VISA or Mastercard:

Name on card: _________________________________________________________

Card #:  _________________________________________Exp. Date:  ____________

SENDERS INFORMATION:

YOUR NAME: ____________________________________________________________

YOUR ADDRESS: ________________________________________________________

YOUR PHONE: ___________________________________________________________

           EMAIL: ____________________________________________________________

Please send this completed form to us with full payment to :     Satsop Bulb Farm   930 Monte Elma Rd.  Elma, WA  98541  Or call in your order to Phone:  360-482-5566