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PALM HAMMOCK ORCHID ESTATE, INC. - ORDER FORM

9995 S.W. 66th St. · Miami, FL 33173

(305) 274-9813

DATE ____________________NAME ___________________________________________

SHIPPING STREET ADDRESS ________________________________________________

CITY __________________________________STATE__________ZIP_________________

PHONE________________EMAIL______________________________

CHECK OR MONEY ORDER ENCLOSED ______________

CARD NO________________________EXP. DATE_________SIGNATURE______________________

QUANTITY PLANT NAME EACH TOTAL

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TOTAL_________________________

6.5% SALES TAX__________________________

(FLORIDA RESIDENTS ONLY)

SHIPPING & POSTAGE____________________

TOTAL ENCLOSED_______________________

If original selections are not available please check one: REFUND__CREDIT__SUBSTITUTE_________

Please list substitute plans on reverse side.