PALM HAMMOCK ORCHID ESTATE, INC.

9995 S.W. 66 St. - Miami, Fl 33173
305-274-9813 - phammock@bellsouth.net
(Please read order information page first)


NAME__________________________________________________DATE ________

ADDRESS_______________________________________________________________

CITY _________________________________________STATE_______________ZIP_________

MC/VISA CARD #__________________________________________EXP DATE____

CARDHOLDER SIGNATURE___________________________________________

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QUANTIY NAME PRICE EACH TOTAL

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ORDER AMOUNT
AMOUNT FROM PAGE 2
TOTAL ORDER
FLA. RESIDENTS ADD 7% SALES TAX
SHIPPING & HANDLING FEE
TOTAL

(List substitutions on this page) NAME QUANTITY NAME PRICE EACH TOTAL






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