Please Print

Please Print
NAME…………………………………………………………………

ADDRESS……………………………………………………………..

………………………………………………………………………….

STATE……………….POSTCODE………………………………….

Phone…………………..E-mail……………………………………….

QTY	NAME OF VARIETY	PRICE




















	POSTAGE
	TOTAL PRICE

IMPRESSIVE IRISES

PO BOX 169

CHARLESTON SA 5244

Ph 08 8389 4439 Fax 08 8389 4439

ABN 85 563 893 808

SUBSTITUTES

(if ordered varieties out of stock)

………………………………………

Colour preference of bonuses

(if more than 3 rhizomes ordered)

………………………………………..

POSTAGE RATES

SA, QLD, ACT, VIC, NSW $7

TAS, WA, NT $11

DELIVERY TIME (Month)

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SPECIAL DELIVERY INSTRUCTIONS

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I enclose my cheque/money order in payment or please charge this to my MasterCard/Visa
My full card number is ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Expiry Date____________________Name on card___________________________________

Signature of card holder____________________________________