ORDER FORM 
KIESEWETTER’S ORCHID GARDENS 
R. F. D, ROSLYN, NEW YORK 
DATE 
SHIP TO 
(PRINT AND PREFIX MR., MRS., OR MISS) R.F.D. NO. 
STREET P.O. BOX 
POST OFFICE ZONE 
STATE 
EXPRESS ADDRESS 
(GIVE ONLY IF DIFFERENT FROM P.O.) 
LC) PARCEL POST Ol AIR MAIL PARCEL POST 
[11 EXPRESS COLLECT C1 AIR EXPRESS COLLECT 
O AIR MAIL O AIR FREIGHT 
CATALOG POT UNIT TOTAL 
QUAN. | numBER DESCRIPTION TUBES! size | PRICE| DOLLARS |CENTS 
(1 SEND ADDITIONAL CRDER BLANKS 
1 CHECK OR MONEY ORDER ENCLOSED 
SIGNATUR 
