Lilac Order Form

Billing Name & Address (Please Print) Shipping Name & Address (If different from billing)

Name: Name:

Address: Address:

City: City:

State: Zip: State: Zip:

Contact numbers: (If we have questions about your order)

Home: ( ) Work: ( ) Email:

Substitutions: We can substitute a similar lilac with the same color if you wish.

Choose substitutions for me Use my substitutions list

Back order if unavailable Refund my money/no substitutions

Please Ship the following lilacs

Qty	Size	Name & Code # of Lilac	Unit Price	Item Total
				$
				$
				$
				$
				$
				$
				$
				$
				$
				$
Lilac Total				$
$7.00 Base Charge plus $1.00 for each Lilac Shipped Shipping				$
Subtotal				$
Maine Residents Add 5% Sales Tax				$
Grand Total				$

Visa Master Card Discover American Express Check

Card Number: ____ ____ ____ ____ / ____ ____ ____ ____ / ____ ____ ____ ____ /____ ____ ____ ____

Expiration Date: ____ ____ /____ ____ / ____ ____

Signature: ____________________________________________________________________

Thank You!