Order Form

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Order Form

Please complete and submit the form below.

Prices are for open-ground fans.

Banking Details: Account name - M I Rosenfels Bank - Standard Bank, Grahamstown

Account Number - 288137701

Payments need to be made by Internet Transfer or Cash Deposits. Proof of payments to be faxed to 046 6250859 or emailed to banksia@imaginet.co.za

Name *
E-mail Address *
Recipient's Phone Home
Recipient's Phone Business
Recipient's Cell Phone
Delivery Address
Postal Code
Is this a gift? Tick your gift choice	Option 1 - Gift Voucher Option 2 - Plants as per my order below
Option 1 - Value of gift voucher - from R100 in units of R10
Complete your order here - quantity, daylily name, price, amount
Sub Total
Postage: R50 per 10 fans per delivery address
Total
Method of payment	Direct Deposit Cash Internet Banking
The following three fields only apply to gift options.Your full name
Your email address
Your Phone Number
Special Instructions - time of delivery, gift message, etc

* Fields marked with an asterisk are required fields

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