ORDER FORM
PLEASE PRINT THIS ORDER FORM, COMPLETE, AND MAIL OR FAX
Zolock Gardens, Steve & Sarah Zolock, 1460 Broad Ave., Belle Vernon, PA 15012
phone: (724) 929-6644 | fax: (724) 929-2597 | email:
sszolock@westol.com
Name
Address
City
State
Zip
Phone
Email
Shipping Date
May We Subsitute?
Yes
No
click here for shipping charges
METHOD OF PAYMENT
Money Order Enclosed
Check Enclosed
(checks payable to Zolock Gardens)
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
.
Pennsylvania residents add 6% sales tax
Shipping: $7 (Priority or UPS ground) + $0.25 per plant
$12 (2-day UPS) + $0.25 per plant
.
TOTAL
.