Noeldrinkingfountain
 

Name:                          ___­_____________________________________________

Shipping Address: (no POs)    __________________________________________

City/State/Zip               ________________________________________________

E-Mail, Phone #        __________________________________

 

SHIPPING DATE                      ____________________________________________________________________________


_________________________________________________________________________________

 

May I substitute?       Yes        No  Please list bonus selections and substitutions on the back of the form. 

 

Make check/money order payable to:  Joe Goudeau, 8550 United Plaza Suite 303 Baton Rouge, LA 70809

 

Qty

Plant Desired

Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Attach pages for additional items)

 

 

Subtotal

 

4% Tax LA resident

 

Shipping:  $10.00(first 5) then 2.00 per double division

 

Total Order

 

 


 

 8550 United Plaza Blvd Suite 303 (225) 413-2172

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