; PACIFIC GARDENS 
A P.O. Box 262 









_Inglewood, California 
“MAILING ADDRESS (Please Print) 
Name A 
Street or R.F.D, ss fn Ve OE nine RIS Sa te 
City & State 
_ AMOUNTS 
t 
} 
t 
i FAS 
%, RET REA. idor Ryan es Ria NR a ae SE SR ER eet Se LES AEE AM LE aes aa scat 
t Please list substitute or pees tutes that we may use if we are sold out of 





_any variety ordered, or nisvik below "No Substitute". 
TOTAL 
AMOUNT REMITTED $ 


California customers please add enh § Sales Tax 
ne eR ne cm ee el a eae ne an area ie er ee et te my 
Se a eR et ne a ro tees ramen 

- =m 
