ORDER SHEET

Mohawk Dahlia Gardens

PO Box 898
Marcola, OR 97454

Tel: (541) 933-2733
Email: mohawkdahlias@aol.com

                                                       ORDER DATE: _____________________

NAME:______________________________________________________________

ADDRESS: __________________________________________________________

CITY:________________________STATE ___________ ZIP CODE: ____________

PHONE: ________________________  Email: ______________________________

REQUESTED  SHIPPING DATE: __________________________

Quantity

NAME OF VARIETY

Price

Amount

                                                                                      SUBTOTAL: __________._____

             Shipping:  1-5 Tubers $6.00       11-15 Tubers  $8.00

                           6-10 Tubers $7.00    Over 15 Tubers  $9.00 (Flat Rate.)

              If more than flat rate box will hold, I will contact you.         SHIPPING: ___________._____

Check or money order must accompany your order.

Credit/Debit cards not accepted.                                             TOTAL: ____________.____