Mail In Order Form

Print and either Fax or Mail the completed order form below. You will be contacted about shipping and payment information before your order is shipped.

Name:__________________________________

Street:________________________

City:__________ State: Zip:

Phone Number: E-Mail:_

Fax:_________________

Qty.	Item #	Description	Unit Price	Total

















------	------	---------------------------------	Grand Total

The Edible Wildflower 708 Salem Avenue Rolla, Missouri 65401-3070
Phone: (314) 364 - 3212 Fax: (314) 368 - 2817

Name:__________________________________

Street:________________________

City:__________________ State:______ Zip:______

Phone Number:______________ E-Mail:_______________

Fax:_________________

City:__________ State: Zip:

Phone Number: E-Mail:_