ORDER SHEET        

Ayers Rainbow of Dahlias

336 Bremner Lane

Winston, OR 97496

(541) 580-8352 or (541) 580-5236
Email: hlmayers@charter.net

ORDER DATE: _____________________

NAME:______________________________________________________________

ADDRESS: __________________________________________________________

CITY:_______________________STATE ___________ ZIP CODE: ____________

PHONE: ________________________  Email: ______________________________

REQUESTED SHIPPING DATE: __________________________

Quantity

NAME OF VARIETY

Price

Amount

                                      Shipping:  1-9 tubers $8.00 SUBTOTAL: __________._____

                                                   10-20 tubers $9.00

                                                 21 +  tubers $12.00   SHIPPING: ___________._____

Check or money order must accompany your order.

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

Thank You