LAURAY OF SALISBURY ORDER FORM
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 A. Fill out this form with the items you'd like to order then mail it to:

 Lauray of Salisbury
 432 Undermountain Rd
 Salisbury CT 06068-1102

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 B. Supply your details:

 First name: _____________________________ Last name: _____________________________
 Address: _________________________________________________________________________
 City: _______________________________ State: _________ Zip code: _________________
 Phone: ______________________________
 Email: ______________________________ 

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 C. Payment options:

 [] Check enclosed.
 [] Visa [] MC Number: _________-_________-_________-_________ Expires: _____/_____

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 D. Order details:

 PLANT NAME                               PRICE EACH       QTY      SUB-TOTAL

 1 _____________________________________  _______________  ________ _______________ 
 2 _____________________________________  _______________  ________ _______________
 3 _____________________________________  _______________  ________ _______________
 4 _____________________________________  _______________  ________ _______________
 5 _____________________________________  _______________  ________ _______________
 6 _____________________________________  _______________  ________ _______________
 7 _____________________________________  _______________  ________ _______________
 8 _____________________________________  _______________  ________ _______________
 9 _____________________________________  _______________  ________ _______________

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 E. Preferences:

 [] Check this box if you authorize substitutions. Otherwise, you'll get a refund.

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 F. Substitutions:

 [ ] ___________________________________  _______________  ________ _______________ 
 [ ] ___________________________________  _______________  ________ _______________
 [ ] ___________________________________  _______________  ________ _______________
 [ ] ___________________________________  _______________  ________ _______________

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 G. Order summary:

 Note: Want to order more? Please continue your          SUB-TOTAL: _______________
 order on a second sheet or on the back.                     * TAX: _______________
 *CT customers please add current sales tax               SHIPPING: _______________
 THANK FOR YOUR ORDER!                                 ORDER TOTAL: _______________

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