ORDER EORM 
To VAN NESS WATER GARDENS 
San Antonio Heights 
UPLAND, CALIFORNIA 
Please accept the following order, in accordance Date 
with terms and conditions given in the “General 
Information” section of your catalog: Our Order No. 
Name . 
St. Address . 
City . State 
Ship Via.to 
QUANTITY 
DESCRIPTION 
UNIT 
PRICE 
AMOUNT 
Amount Enclosed $ 
TOTAL $ 
Signed 
