Name:_________________________________________
      Complete address: _______________________________
      ______________________________________________
      ______________________________________________
      Optional: phone number:__________________________
      E-mail: _______________________________________  
      nb of packets
      		  item name 
      		total
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      		 ______________________________________
      		 ________
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      		 ______________________________________
      		 ________
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      		..........................................................subtotal ________

      		S&H  Canada $1,50  US: $2   International: $6 ________

      		..............................................................Total _______

      Send to:
      SOLANA SEEDS
      17 place Leger
      Repentigny, Quebec
      Canada
      J6A 5N7
      Print other forms if you order more than 20 items.