Russian River Rose Company
1685 Magnolia Drive, Healdsburg, CA 95448
(707) 433-7455     FAX: (707) 433-5683

Order/Registration Form
Please print this form out and, with Payment, Mail or FAX it to us.
NOTE: Minimum Order $29 Date:___________ ORDERED BY: or REGISTRANT:
Name: _____________________________________________________________________
Street:____________________________________________________________________
City, State, Zip:__________________________________________________________
Telephone:___________________E-mail:_______________________________________
SHIP TO: (if different from above)
Name:______________________________________________________________________
Address:___________________________________________________________________
City, state,Zip:___________________________________________________________
PRODUCT ORDER FORM
PRODUCT QUANTITY PRICE TOTAL
Pruning Workshop Fee _______ $25.00 ea. __________ Propagation Wrkshp Fee _______ $5.00 ea. __________ Tool Belt _______ $24.95 ea. __________ Tool Belt "Loaded" _______ $29.95 ea. __________ Organic Tea (spcify flvr) _______ $3.75 bx. __________ __________________________ __________________________ 1/6 oz. Eau de Toilette _______ $28.00 ea. __________ 1/6 oz. Eau de T.-wrapped _______ $29.50 ea. __________ 4 oz. Rose Water _______ $16.00 ea. __________ SUBTOTAL __________ (no sales tax on Pruning Workshop fee) 7.75% CALIF SALE TAX __________ (will pick up order & RRRCo on ________________ SHIPPING =$ 0.00 with pick up ) (SHIPPING= $ 7.95 for order less than $29.00 ) (SHIPPING= $ 9.95 for order of $29-$53 ) (SHIPPING= $11.95 for order of $54-$78 ) (SHIPPING= $13.95 for order more than $78 ) SHIPPING __________
GRAND TOTAL __________

METHOD OF PAYMENT: |_| CARD # (M.C., Visa, & Discover only) EXPIRATION DATE (MM/YY) _______  _______  _______  _______    ____ /____ ZIP CODE: ___________ CARD HOLDER'S NAME:___________________________________________ |_| CHECK ENCLOSED: Make out to Russian River Rose Co