Wildflowers Unique Books & Gifts

Printable Order Form

 Name:

 ______________________________________________________    

 Address:

 ______________________________________________________

 City/State/Zip:

 ______________________________________________________

 Phone #:

 ______________________________________________________

PRODUCT NAME & ITEM #  (We need both to process)  

  QTY  

  PRICE  

  TOTAL  

       
       
       
       
       
       
       
       
       
       
       
       
                  
       Sub-Total  
      West Virginia only customers add 6% Sales Tax  
Shipping         $4.50
                                                                                                            Total  

CREDIT CARD TYPE________________ Cardholder Name______________________________________ NUMBER___________________________________________________ EXPIRATION DATE____________ SIGNATURE_______________________________________________________________ DATE__________
Cash or Make check or money order payable to:
Wildflowers
 1512 Oakhurst Drive
Charleston, WV 25314