To : Taylors Clematis Nursery
Sutton Road, Sutton
Askern,Doncaster
DN6 9JZ
South Yorkshire
United Kingdom

Date of Order :      /     /


Please supply the plants below to:

( Mr / Ms / Mrs / Miss ) : ..........................................

Address : .....................................................................
......................................................................................
Postcode : ......................Tel : .....................................

Please Note : A signature is required on delivery of your
plants. If there are any special instructions please indicate.
.....................................................................................
.....................................................................................
.....................................................................................
.....................................................................................

Payment by Cheque : Please write your name and address
                                         on the back of the cheque.


Payment by Credit Card : Please tick box below

 
VISA SWITCH
DELTA MASTERCARD
SOLO  
 
My Card Number is :
                               
CCV2 Number (3 diget code on back of card)
     
Expiry Date :   /     /
Issue No :
............................
   
( Switch & Solo only )
Signed :     .....................................................................
Please print the name which is on the card :
........................................................................................
 
 
 
 
If your choice of variety is out of stock and you wish to be placed on a waiting list, Please tick the box at the side of each variety.
Name of Variety
£
P
     
     
     
     
     
     
     
     
     
     
     
     
     
Total Price of Plants
   
Plus Postage Cost
   
Total Amount
   
I agree to your terms and conditions and have also checked that all my information given on this order form is correct.
Signed ...............................................................................
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