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Order Form

12414 - 191st Street East                Tel: (651) 437-7516
Hastings, Minnesota 55033              Fax: (651) 437-7195
                    Email: info@kedemroses.com

  1. Please provide the following ordering information:
    SHIPPING

    Name

    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Telephone
    Fax
    Email
    Shipping Date
    Substitutions Yes    No

     

    QTY SIZE ITEM PRICE TOTAL

    Sub Total
    Discount
    MN Sales Tax  (6.5%)
    Shipping Charges Shipping and Handling
    TOTAL

    You may select CC (see "Billing Information" below), or call @ 651/437-7516.   You may select other payment options via mail.

    Note: Gift Certificates need to be submitted to our office.

    BILLING INFORMATION
    Credit Card
    Cardholder Name
    Card Number
    Expiration Date
    CVI* *3 last digits on the back of the card

Copyright © 1999 [Sam Kedem Nursery]. All rights reserved.
Revised: April 02, 2005