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Pense Nursery Inc.                                      Phone:(479) 369-2494
2318 hwy 71 N.E.                                        Fax:  (479) 369-2490
Mountainburg, AR 72946

Date of order placement:____________________________________________________

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                            


PLEASE SPECIFY SHIPPING DATE: ______________________________________________
                     Note: Shipping dates start in October and end in April.

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| Item                                         | QTY |   Each   |  Total   |
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                             (Minimum order - $30.00) SUB TOTAL |          |
                                                                |----------|
                                  For AR orders, add sales tax. |          |
                                                                |----------|
                   Shipping & Handling (20% with $12.00 minimum)|          |
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PAYMENT METHOD:                                           Total |          |
                                                                ------------
( ) Check Enclosed, Make check payable to "Pense Nursery Inc.".

( ) MasterCard,  Visa, American Express or Debit Card

    Card Number: ______________________________  Expiration Date: __________ 

    Signature:_______________________________________