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. 

Qty
Code
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 $____________

          TOTAL $____________

(All prices in Canadian funds)