BUYER’S NAME AND ADDRESS: QUALITY FLOWERBULB BROKERS


335 S. High St. Randolph WI 53956


SPRING 2013 ORDER FORM


ORDER BY PHONE: 1-800-883-6998 Mon-Fri 8:00 a.m. to 4:30 p.m. CST


Extended Hours January 15 – May 15: Mon-Fri 7:30 a.m. to 5:30 p.m. CST Sat 8:00 a.m. to 3:00 p.m. CST


ORDER BY FAX: 1-800-374-6120 Available 24 hours a day, 7 days a week


ORDER ONLINE: www.mzbulb.com


Available 24 hours a day, 7 days a week


CUSTOMER SERVICE: 1-800-546-4053 Mon-Fri 8:00 a.m. to 4:30 p.m. CST E-MAIL: info@mzbulb.com


PAYMENT METHOD:


❑ MASTERCARD Credit Card No.


FOR OFFICE USE ONLY


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


(PLEASE DO NOT SEND CASH)


❑ Check or money order ❑ Gift Certificate ❑ VISA


❑ DISCOVER ❑ AMERICAN EXPRESS


IMPORTANT - VERIFY YOUR ADDRESS. Please make corrections to the pre-printed address above. If the address is not pre-printed, write in your complete address.


PLEASE NOTE: If you are paying by credit card, the above address MUST MATCH the address on your credit card statement.


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.


Daytime Phone ( Evening Phone (


E-MAIL ADDRESS SHIP TO:


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


P.O. BOX (if applicable) CITY


Signature of card holder LINE#


1 2 3 4 5 6 7 8 9


10 11


12 TOTAL OF ABOVE


Planting Information will be included with every order.


PACKING AND DELIVERY CHARGES Includes import duties, packing, insurance and delivery charges to your home.


Amount of


order


Under $60.00


Include Minimum $6.00


Between $60.00 and $500.00


Merchandise Total


10% of $500.00


Maximum $50.00


SHIPPING RESTRICTIONS: We no longer ship to AK, HI or outside the continental U. S.


Over


AMOUNT FROM OTHER SIDE Packing, Insurance & Delivery Charge (see chart)


MERCHANDISE TOTAL


Less 10% discount on merchandise total if order is received by March 1, 2013


Additional Shipping Addresses – add $5.00 each ORDER SUBTOTAL


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


Add CAT #54500 Gift Purchases (from reverse side) Deduct McClure & Zimmerman credits (if any) ORDER TOTAL


ITEM # QUANTITY Expiration Date


IMPORTANT: Buyer’s address MUST MATCH the address shown on your credit card statement. Credit cards will be charged when order is placed.


NAME OF VARIETY 10% discount on orders received by March 1, 2013.


SURPRISE BONUS BULBS are sent with all $25.00+ orders.


PAGE # PRICE ) )


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


(Use only if different from address shown above)


STATE


ZIP


IMPORTANT – VERIFY YOUR SHIPPING ADDRESS! Be sure to include a complete physi- cal 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 delivery before February 1 or after May 1. We can only ship items that are in stock on the requested ship date. Please add $15 to the last merchandise line of your order, along with your requested ship date.


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.


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


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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