Heirloom Roses Canada

ORDER FORM

NURSERY: 161 Pockwock Rd. (Off of Hammonds Plains Rd) Hammonds Plains, Nova Scotia, Canada B4B 1M6

MAILING: P.O. Box 9106, Stn. A, Halifax, NS Canada B3K 5M7 Fax: (902)-835-0653

Please fill in all fields and submit. All information submitted is for ordering purposes only and is kept confidential.

No information is given or sold to anyone under any circumstances.

We will respond with a confirmation /invoice as soon as possible. Upon confirmation you can email us stating you wish to proceed with the order.

Thank you.

Customer Mailing & Contact Information

Name

Address 1

Address 2

City Prov./State

Postal code/Zip Code Telephone

Fax Email (required)

Substitutions Yes No

Quantity Name/Description Unit Price Total

Plants Total

Phytosanitary

Phytosanitary Certificate is required for plants to enter the U.S. This is $10.00 per order. Shipping Charges

(Canada Only where applicaple)) GST /HST

Total

Please type in any questions or inquiries you may wish to as us.

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