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            ORDER FORM
    1685 Magnolia Drive, Healdsburg, CA 95448
     (707) 433-7455 | FAX (707) 433-5683 
         info@russian-river-rose.com

 

    Please print and mail (with payment) or FAX.
                Minimum Order $28


ORDERED BY:                     Date: ______________
Name   _____________________________________________
Street _____________________________________________
       _____________________________________________
City _______________________ State______ Zip: ______

Telephone: (_____) _______________
E-mail_____________________________________________

SHIP TO: (if different from above)
Name   _____________________________________________
Street _____________________________________________
       _____________________________________________
City _______________________ State______ Zip: ______

Telephone: (_____) _______________
E-mail _____________________________________________

Will pick up from RRR Co on _____________________


PRODUCTS:

PRODUCT                       QUANTITY    PRICE      TOTAL

Pruning Workshop              ______    $40.00 ea.  ______
Propagation Workshop          ______    $10.00 ea.  ______
ToolBelt                      ______    $48.95 ea.  ______
1/6 oz. Eau de Toilette       ______    $34.00 ea.  ______
1/6 oz. Eau de Toilette boxed ______    $35.50 ea.  ______
2 oz. Rose Water w/spritzer   ______    $16.00 ea.  ______
4 oz. Rose Water              ______    $24.00 ea.  ______
                                           SUBTOTAL ______
(no sales tax on Pruning Workshop fee)
SHIPPING= $ 0.00 with pick up
SHIPPING= $ 9.95 for order of $28-$53
SHIPPING= $11.95 for order of $54-$78
SHIPPING= $13.95 for order more than $78
SHIPPING TOTAL
                                   8.5% CA SALE TAX ______
                                        GRAND TOTAL ______

PAYMENT METHOD:
/__/ MasterCard Visa only
      CARD NUMBER              EXPIRATION DATE   SECURITY CODE
                                     (MM/YY)
      ______ _______ ______ ______  ____/____    _______

      CARD HOLDER NAME________________________________

/__/ CHECK ENCLOSED Made out to "Russian River Rose Co."