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ORDER FORM		  
  Note Shipping in the continental US is $8.00

Instructions: Print this form. Write in your order and fax it to us at (603) 536-6353.  If you need assistance or have any questions, please call us at (603) 536-7626.
Name: ___________________________________________
Address:
for shipping		 ___________________________________________
___________________________________________
___________________________________________
Telephone: (       ) ____-__________
Stock #   Description  Price ea. Quantity Extended
Amount
         
         
         
         
         
         
         
         
         
         
 

Subtotal:

  

Shipping & handling:

  
 

TOTAL:

  
Master Card / Visa
Discover / AmExp		 Expiration Date: _____/_____
Card # ______-______-_____-______
Signature (as it appears on your card): ____________________________
Mail form to:   Foxgloves, 89a Main St.
  Plymouth, NH 03264
or FAX:   (603) 536-6353