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2010 De Bruyn Seed Store Mail Or Fax Order Form
| Name: ____________________________________________ |
Address: ________________________________________ |
| City, State, Zip: ________________________________________ |
Daytime phone: ____________________________________ |
| Method of Payment: Check: ____Visa:____ MasterCard:
_____ C.O.D. _____ |
Credit Card Number: ________________________________ |
| Expiration Date: _______
3 Digit Code:_______ (found on back of card) |
Signature: _________________________________________ |
| Name & Description of Seed |
Quantity |
Unit Price |
Price |
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| Total from this side: |
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| Total of other side: |
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| SUBTOTAL: |
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| MI Residents add 6% sales tax |
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| Shipping & Handling: (from
e-mail) |
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| C.O.D. Charges ($10.00) |
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| TOTAL: |
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| Shipping Charges: |
Under 1 lb. Add $5.95 |
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1 lb to 5 lb. Add $11.50 |
| Shipping outside the continental US: Please contact us for
the shipping prices. |
Please e-mail or call me for the shipping prices at
debruynseed@att.net or 616-772-2316
Thank you. Jan |
If you need more room, just use the back side
of this form once it is printed.
Remember: Michigan residents must add 6% state
sales tax
Bean Price List
Corn Price List
Pea Price List Small Vegetable Seed Price List Flower Price List
Potato & Onion Prices
Native Grass Price List
Fall Bulbs Price List Grass
Seed Prices De Bruyn Seed Home Page
E-mail Order Form
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