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Arkansas Berry & Plant Farm                        Phone or Fax: 479-806-7810 
P. O. Box 143.
Chester, AR 72934                                                 

SOLD TO:                                 SHIP TO: (If not the same)

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Name                                     Name

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Address                                  Address

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City, State, Zip                         City, State, Zip

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Phone Number                             E-Mail Address


|                                              |     |    P  R  I  C  E    |
| Item                                         | QTY |   Each   |  Total   |
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|                                              |     |          |          |
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|                                              |     |          |          |
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|                                              |     |          |          |
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----------------------------------------------------------------+----------|
                                                      SUB TOTAL |          |
                                                                |----------|
                                            Shipping & Handling |          |
                                                                |----------|
                                                          Total |          |
                                                                ------------
Approx.  Shipment date:______________________________________________________
Make check payable to "Arkansas Berry & Plant Farm".