Botanical Prints & Ferns Order Form


Name (please print): ________________________________________________________

Address: ___________________________________________________________

City: ______________________________ State: ___________ Zip Code: ______________

Day Phone: ( )________________ E-mail: ________________________ @______________


Fern  or
Design Name
Quantity
Gold Frame
 Olive Frame
Without Frame
Price
        $
        $
        $
        $
        $
        $
Subtotal:         $
S & H*          $
NY residents: add 8.25% tax         $
TOTAL:         $
 

*S & H: 8x10: $10; 9x11: $12; all others: $15

Method of Payment:
(Please, NO credit card information via e-mail)

[ ] Check

[ ] Visa      [ ] Mastercard
Card Number:_____-______-______-______ Expiration Date (month, year):___ /___

Signature: _______________________________________________________________


Please mail this form (& payment) to:
Mireille Munnelly - De Mon Jardin
48 Pine Drive
Pawling, NY 12564-1208

Telephone: (845) 855-9097