MacArthur Holly Farm - 354 Sparton Road - Victoria, BC - Canada - V9E 2H5
Phone: (250) 479-6208 - Email: bcholly@shaw.ca

FROM: (Please print clearly)

Name:                                                                                     Date ordered:

Address:
City:                                      Province/State:                            Postal/Zip Code:

Phone (home):                                                                         (work):                
Special Instructions:
Method of Payment:               Visa            M/C             Cheque           Money Order
Credit Card Number:                   |                    |                    |                     Expiry:            /    

SEND TO: (Please print clearly)

1. 
Qty
Code
Price

Name:

      

Address:

      
City:                             Prov/State:                   Postal/Zip:      

Phone (home):                                                 (work):                

      

2. 
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Price

Name:

      

Address:

      
City:                             Prov/State:                   Postal/Zip:      

Phone (home):                                                 (work):                

      

3. 
Qty
Code
Price

Name:

      

Address:

      
City:                             Prov/State:                   Postal/Zip:      

Phone (home):                                                 (work):                

      

4. 
Qty
Code
Price

Name:

      

Address:

      
City:                             Prov/State:                   Postal/Zip:      

Phone (home):                                                 (work):                

      

Subtotal $____________
In Canada add applicable taxes (for BC 12% HST) $____________

          TOTAL $____________

(All prices in Canadian funds)