Name:                          ___­_____________________________________________

Shipping Address: (no PO’s)    __________________________________________

City/State/Zip               ________________________________________________

E-Mail, Phone #        __________________________________

Credit Card Information :

_________________________________________________________________________________

Credit Card Number                      Exp Date                Name as it appears on Card

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

Make check/money order payable to:  Daylilies Etc., 11754 Blackwater Road, Baker, LA 70714