IF ORDERING BY MAIL, WE ACCEPT CHEQUES AND M.O.
SEND PAYMENT TO:


Jerry Siegmund
1414 - 20th Street North
Lethbridge, Alberta, Canada
T1H 3P2


Your Name: __________________________________________________
Address:      __________________________________________________
City: ______________________________ State/Prov.:________________
Zip/P.C. : ______________________     Country: _____________________
Phone: ____________________________ E-mail: ____________________
                                                                                                                                                       
SEED #          SEED DESCRIPTION                         QTY.    PRICE EA.     TOTAL

[_______]___________________________________]________[_________]

[_______]___________________________________]________[_________]

[_______]___________________________________]________[_________]

[_______]___________________________________]________[_________]

[_______]___________________________________]________[_________]

[_______]___________________________________]________[_________]

                                                                  SUB TOTAL  $ _______US               
                      
SHIPPING AND HANDLING   
(US ORDERS )                                           $3.50 US
SHIPPING AND HANDLING  
( CANADA )                                             $3.50 US

OVERSEAS ORDERS                                        $10.00US

                             TOTAL AMOUNT        $___________USD


MAY WE SUBSTITUTE? [ ] YES [ ] NO  IF YES, PLEASE LIST ALTERNATE SEEDS BELOW:
______________________________________________________________________________________________________________________________________________