Countryside Roses
5016 Menge Ave.
Pass Christian, MS 39571

www.countrysideroses.com
mail@countrysideroses.com 
  To avoid delays, please fill out the form completely, click 
   the submit button when completed, print out a copy for yourself, 
   and mail your payment to the address above.  Please list any 
   substitutions you will accept.  Please note any specific requests 
   or comments in the space provided.
First Name               Last Name
Shipping Address
City                       State
Zipcode                

Phone Number (with area code) E-mail

Quantity
Item (Name of Rose)
Price Each
Total
Shipping + Handling ($7.00 per order + $2.00 per plant
Add Sales Tax of 7% (MS only)
Total Cost

Alternative Selections:
For This Rose You May Substitute This Rose


Comments: