LaCygne
Daylily Farm, LLC

 

 

Order Form

PLEASE PRINT THIS PAGE, COMPLETE, AND MAIL OR FAX
LaCygne Daylily Farm, 21117 East 2100 Road, LaCygne, Kansas 66040
Fax-913-757-4544

Name
Address
City
State	Zip
Phone
Email
Shipping Date		May We Subsitute? Yes No

METHOD OF PAYMENT

Check Enclosed    Money Order Enclosed       PayPal Payment Sent

	QTY	CULTIVAR	PRICE				QTY	CULTIVAR	PRICE
1	.	.	.	.		12	.	.	.	.
2	.	.	.	.		13	.	.	.	.
3	.	.	.	.		14	.	.	.	.
4	.	.	.	.		15	.	.	.	.
5	.	.	.	.		16	.	.	.	.
6	.	.	.	.		17	.	.	.	.
7	.	.	.	.		18	.	.	.	.
8	.	.	.	.		19	.	.	.	.
9	.	.	.	.		20	.	.	.	.
10	.	.	.	.		21	.	.	.	.
11	..	...	..	..		22	..	..	..	..

Gift Certificate Amount	.
Sub-Total	.
Kansas residents please add 5.3% sales tax
$10.00 per shipment plus $.50 per plant
TOTAL	.