Violet Gallery
1590 Cranberry Road, York Springs, PA 17372
Ph (717)528-8268 Fax (717)528-8923

To print this form, just hit the PRINT button at the top of your screen. Please fill it out and either fax it or snail mail it to us. If you are using Internet Explorer, just click File, Send, Page As Email, to violetgallery@embarqmail.com. It will appear in the body of the messsage where you can fill it out and email it to us. You can also order by clicking the 'Contact Us' link at the bottom of this page. We accept Visa, MasterCard, Amex, Discover, check and money orders.

PRICES ARE AS FOLLOWS:

The price of our supplies is shown in the catalog. I will weigh the package and calculate shipping. Usually supplies will be shipped by Parcel Post. If you pay with a credit card I will calculate the shipping before I charge the card. If you prefer to pay with a check or money order, I will contact you with the shipping cost and you can send your payment.

 
IMPORTANT: If you are CHARGING the order, I will need your home STREET ADDRESS even if you want it shipped to a PO Box or work address.
NAME - ___________________________________________
STREET ADDRESS-________________________________________
__________________________________________________
__________________________________________________
                          ~SHIP TO if different from above~
PHONE -
FAX -
EMAIL -
     
~Alternate Contact Info.~
NAME - ___________________________________________
ADDRESS- ________________________________________
__________________________________________________
__________________________________________________
PHONE -
FAX -
EMAIL -
QTY. Leaf Variety or Supplies
EACH
TOTAL
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
  Substitutions    
       
       
       
       
       
       
Visa/MC/Amex/Discover #__________________________
Exp.Date ________     Sec.Code                 
Order Total
 
  Shipping  
Subtotal
 
   
(For Pennsylvania Residents)  6%PA Tax (also on shipping)
 
        TOTAL  

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