Detach along perforated line above, and moisten here to seal envelope.


334 West Stroud St. Ste 1 Randolph, WI 53956-1341 HPS SEED & PIXIE® LABEL ORDER FORM


Payment methods: (Please do noT send cash) ❑ Check or Money Order ❑ Charge to Account*


FOR OFFICE USE ONLY


❑ VISA ❑ MasterCard ❑ DISCOVER


Account # _______________________ ❑ AMERICAN EXPRESS *Charge Orders accepted only if credit has been previously approved by our


HPS Grower Division. If not previously approved, send payment with order to avoid any delay.


Credit Card No. _______________________________________________________


_______________________________ ________ Signature of Card Holder


Expiration date Credit Card will be charged when order is placed


If you pay by check and your check is returned to us, it will be represented electronically and your account will be debited for the amount of the check plus a fee of $35.


IMPORTANT NOTICE!! CHECK ACCEPTANCE POLICY


If we run out of an item, may we substitute a similar variety of equal or greater value? ❑ Yes ❑ No


Substitution Service


❑ We occasionally make our mailing list available to carefully screened companies we think may be of interest to you. If you prefer we do not include your name please check box.


Our Mailing List CATALOG # PG. #


1 2 3 4 5 6 7 8 9


10 11 12 13 14 15 16 17


Minimum order 3,000 – See Back Cover for details. Quantity


Prices On Pixie® Stakes All Postpaid!


If Ordered By 9/30/11


37.50 per 1,000 31.00 per 1,000


If Ordered After 9/30/11


3,000-4,900 $40.50 per 1,000 $44.50 per 1,000 5,000-9,900


10,000-24,900 33.00 per 1,000 25,000-up


41.50 per 1,000 36.50 per 1,000 34.50 per 1,000


TOTAL NO. OF PIXIES – THIS PAGE & REVERSE TOTAL PRICE OF PIXIE STAKES (See Chart at left) TOTAL PRICE OF SEEDS THIS PAGE TOTAL PRICE OF SEEDS REVERSE SIDE


MINIMUM SERVICE & HANDLING CHARGE PER ORDER


WI ORDERS ADD 5% SALES TAX PLUS APPLICABLE SALES TAX FOR YOUR COUNTY


TOTAL AMOUNT ENCLOSED (Make check or Money Order payable to HPS Grower Division)


133 132 ➞ $8.95 CODE QTY SIZE


Date ___________ Init _________ CK _________________________ CA _________________________ CR _________________________


G ___________________________ T ___________________________ CID _________________________ O# __________________________


IF ADDRESS IS PRE-PRINTED ON THE BACK OF CATALOG, FILL IN BELOW EXACTLY AS IT APPEARS, NOTING ANY CHANGES.


FIRM OR INDIVIDUAL __________________________________________ ADDRESS __________________________________________________ CITY____________________________ STATE ______ ZIP____________ DAYTIME PHONE (____)________________________________________


EMAIL ADDRESS _____________________________________________ Q For shipping confirmation via e-mail, please provide your e-mail address. Q


Ship To: Use Space below ONLY if different from above Name _______________________________________________________________ Address ______________________________________________________________ City ________________________________________ State _____ Zip __________


NAME OF ITEM WANTED


PRICE NO. OF PIXIES


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