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Vermont Bean Seed Co 334 W. Stroud St.


Randolph WI 53956 2012 ORDER FORM


In a Hurry? Place your order via phone, fax, or online using your credit card!:


ORDER TOLL FREE 1-800-349-1071 Mon-Fri 8:00 am to 4:30 pm CST


Special Extended Phone Order Hours From January 15 - May 15:


Mon-Fri 7:30 am to 5:30 pm CST Sat 8:00 am to 3:00 pm CST


FAX TOLL FREE 1-888-500-7333 Available 24 hours a day, 7 days a week


ORDER ONLINE www.vermontbean.com Available 24 hours a day, 7 days a week


E-MAIL: info@vermontbean.com


❑ Check or money order ❑ Gift Certificate ❑ VISA


❑ DISCOVER ❑ MASTERCARD ❑ AMERICAN EXPRESS


Credit Card No. Signature of card holder


Line #


1 2 3 4 5 6 7 8 9


10 11


12 13 14 15 16 17 18 19 20 21


Expedited Shipping Upgrade


Your expedited shipment (Limited to 5# of seed or less) will be shipped via FedEx, Priority Mail, or First Class. We process the orders in the only fair way we know, - in strict rotation, with those arriving first, shipping first. However, once your order has been readied for shipment, we would be pleased to expedite delivery of the parcels containing 5# or less of seed only. Te charge will be next day - $39.95; Second-Day $29.95; Expedited Shipping $15.00 (usually 2 to 5 business days depending on distance from Randolph, Wi). If you desire faster shipping, please indicate so on the Order Form by including the proper charge in the appropriate area marked "Expedited Shipping". Please note AK & Hi requires Expedited Upgrade.


MERCHANDISE TOTAL (Page 1 Above) MERCHANDISE TOTAL (Other Side of Form) Handling Charge


ORDER SUBTOTAL Expedited Upgrade (See Instr to Left)


ORDER TOTAL AK&HI Required for shipping to AK & HI


WISCONSIN ORDERS – Add 5% sales tax plus applicable sales tax for your county


Size Code Qty Page Expiration Date


NOTE: Credit cards will be charged when order is placed. Item #


Variety Name FOR OFFICE USE ONLY


Date..................Init .......... CK .................................... CA .................................... CR .................................... G ....................................... T ....................................... CID .................................. O# ....................................


PAYMENT METHOD: (PLEASE DO NOT SEND CASH)


PLEASE MAKE CORRECTIONS TO PRE-PRINTED ADDRESS ABOVE. IF THE ADDRESS IS NOT PRE-PRINTED, WRITE IN YOUR COMPLETE ADDRESS.


We request that all members of the same household order under one name. NOTE: A street address must be included so delivery carriers can locate you.


❑ Check box if a gift order. Complete gift form on the back. Daytime Phone ( Evening Phone (


) )


❑ Check box if you are interested in receiving our email newsletters and special offers.


E-MAIL ADDRESS (Order confirmation and shipping information will be sent by E-mail)


SHIP TO: NAME


(Use only if different from address shown above)


PHYSICAL ADDRESS Include street, road, fire no., etc. so our delivery carriers can locate you.


P.O. BOX (if applicable) CITY


Price


STATE


ZIP


IMPORTANT – VERIFY YOUR SHIPPING ADDRESS! Be sure to include a complete physical address (street, road, fire number, etc.). Postal and delivery services will not forward. We can only guarantee delivery to addresses we are given.


REQUESTS FOR SPECIAL SHIP DATES: Special ship date requests require an extra $15 handling fee. No special ship dates are accepted for de- livery before February 1 or after May 1. We can only ship items that are in stock on the requested ship date.


LEAVING ON A TRIP? Please make arrangements for care of your package if it arrives while you are gone. We cannot be responsible for orders that are not properly cared for once they are received.


SHIPMENT NOTIFICATION: We will notify you when your order is shipped and will also provide tracking information if you provide us with your E-mail address in space above.


SUBSTITUTION SERVICE If we run out of an item, we often can provide a similar variety of equal or greater value. If you do NOT want a substitute, please check the box below.


❑ NO SUBSTITUTIONS $6.95


YOUR PRIVACY IS IMPORTANT TO US We occasionally make our mailing list available to carefully screened compa- nies whose products or services may be of interest to you. If you do not want your name shared, please check the box below.


❑ DO NOT SHARE MY NAME


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

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