ORDER FORM 
To VAN NESS WATER GARDENS 
San Antonio Heigchts 
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 
