Print this form and mail with check payable to:

Parent Resource Center
811 Fifth Street
Modesto, CA 95358

Or call us at (209)549-8193 to order using your credit card.

DELIVERY DATE – THURSDAY, DECEMBER 1, 2011
(Delivery available for 4 or more 6" plants and/or any number of large plants)

Order deadline – Monday, November 21, 2011


Name:_______________________________________________________

Delivery Address:

Street: ______________________________________________________

Phone: (H) _______________________(W)_________________________

QUANTITY COLOR

Regular | Large

_______|_______ Red

_______|_______ White

_______|_______ Pink



Total Regular Plants - ___________ x $12.00 = ______________

Total Large Plants - _____________ x $30.00 = ______________

TOTAL COST = _______________

Make checks payable to: Parent Resource Center

Mail to: P.O. Box 582893, Modesto, CA 95358

CREDIT CARD PHONE ORDERS AVAILABLE
(209)549-8193.
You may also place your order securely online through PayPal.