Antoine Seed Sample Order Form

Sample Order Form

3 Simple Steps:

(1) PRINT this page, (2) Fill in all the information, (3) FAX: (816)252-5083, PHONE: (816)252-8860, or MAIL the Order Form to us.

Go back to Order Form page.

Name Mr. Joe Sample Payment Method
Address                   1234 Maywood Drive       Check
Address Apt. #4 Credit Card Visa
City Independence Name on Card Joe Sample
State Missouri Card Number       1234 5678 1234 5678
Zip Code 64052 Expiration Date           03 / 2003
Phone 816-xxx-xxxx

Name	Mr. Joe Sample	Payment Method
Address	1234 Maywood Drive	Check
Address	Apt. #4	Credit Card	Visa
City	Independence	Name on Card	Joe Sample
State	Missouri	Card Number	1234 5678 1234 5678
Zip Code	64052	Expiration Date	03 / 2003
Phone	816-xxx-xxxx

Quantity Unit Size Product Description Unit Cost of Seeds or Spices Total
1 1/4 lb Pumpkin Seed - Autumn Gold $18.00 $18.00
4 1 oz Spice - Beef Bouillon 0.65 2.60
2 1/2 lb Watermelon Seed - Jubilee 7.00 14.00
1 1 lb Popcorn Seed - Yellow Purdue 6.00 6.00

Sub Total $40.60
Sales Tax @ 0.076 $43.68
Total Weight = 1 - 5 lbs so add $12.00 Add Shipping charge $12.00
Total $55.68

Quantity	Unit Size	Product Description	Unit Cost of Seeds or Spices	Total
1	1/4 lb	Pumpkin Seed - Autumn Gold	$18.00	$18.00
4	1 oz	Spice - Beef Bouillon	0.65	2.60
2	1/2 lb	Watermelon Seed - Jubilee	7.00	14.00
1	1 lb	Popcorn Seed - Yellow Purdue	6.00	6.00

			Sub Total	$40.60
			Sales Tax @ 0.076	$43.68
Total Weight =	1 - 5 lbs	so add $12.00	Add Shipping charge	$12.00
			Total	$55.68

Most orders are shipped out in 24 hours from receipt of order. Order form can be used for FAX, PHONE or MAIL ORDERS.