Select Plus International Nursery
1510 Pine, Mascouche, Quebec,
J7L 2M4, Canada
tel./ fax: 450-477-3797
e-mail: lilacs@spi.8m.com
DATE
SPECIAL ORDER # __________
Shipped
Sender:___________________
Name and Ship address
Address:_________________
Town/City ________________
State/prov:
________________
Zip/ postal:
______ __________
Tel:
_________________
email
_________________
For US customers because we are a Canadian company credits
cards are charged in Canadian dollars and the company you deal
with will reconvert it on your monthly statement. We
use the exchange rate that our bank uses when charged.
Will you accept a size sub yes
no
variety sub yes
no
Lilac
Quantity
Price
Total
1-
2-
3-
4-
Free mini photo album ______ or free photo frame
______
Plant subtotal __________
Shipping $6.00 for 1 lilac USA
$10.00 for 1 lilac Canada
add $4 for a second plant
total ___________
name (as on card)
Visa, Mastercard
______/ ______/ _______/ _______ expiry date _________
I authorize Select Plus Int Nursery to charge this
to my credit card for this purchase only.
X
For office use only USD$
x
Cdn exchange rate=
Canadian $
Canadian customers please add applicable sales tax