Itasca Greenhouse, Inc. 26385 Blackwater Road P.O. Box 273 Date______________ Cohasset, MN 55721 Desired Shipping Date:____________ Or Desired Pick Up Date:___________ Remarks:___________________________________________________________________ Billing Address: Name:___________________ Phone:_____________________ Company Name:__________________________Email address:________________________ Address:_________________________________ City:__________________________State:___________Zip:__________ Delivery Address: ___Same as above Phone at Delivery Point:_______________ Email at delivery location___________________________________ Name/Company Name:________________________________ Address:__________________________________________ City:__________________________State:___________Zip:___________ E-Mail Address:_______________________________________________ Tree Species Size or Quantity Price Total or Product Container Each ____________ _________ _________ _________ __________ ____________ _________ _________ _________ __________ ____________ _________ _________ _________ __________ ____________ _________ _________ _________ __________ ____________ _________ _________ _________ __________ ____________ _________ _________ _________ __________ Total No. Trees:_________ Total Cost: $_________ Shipping/Delivery: Zone Rate/1000:__________x Trees (1000) $_________ Other shipping and handling charges:________________________ $_________ Container Deposit:_________ $_________ Other Charges/Credits:______________________________ $_________ (TAX EXEMPT - Total Amount Due: $_________ Please attach a copy 25% Deposit Due with Order: $_________ of certificate) Sales Tax MN sales only 6.5% $_________ Balance Due on Receipt of Order Prior to Shipping: $_________ Visa__ Mastercard:__ Customer Signature:_________________________ Date:______________ Card Number:____________________________Exp. Date:_________3 Digit Security Code____ Terms: 25% with order, balance due on delivery. Customers qualifying for credit, terms are 25% with order, balance due in 30 days of delivery. If order is cancelled, down payment is forfeited. Past due accounts will be charged 1.50% per month, compounded monthly. The customer is liable for all collection charges. Customer Signature:________________________ Date:_________________ Please sign and return with deposit or purchase order Disclaimer: Itasca Greenhouse, Inc. makes no warranty on merchantability of its stock or its fitness for any particular purpose... and makes no other warranties expressed or implied. This sales transaction is strictly on an "as is" basis subject to the customer's acceptance on receipt. In no event shall Itasca Greenhouse, Inc. be liable for any direct, indirect, special incidental or consequential damages, (included, but not by way of limitation, economic losses and lost profit incurred or claimed by customer).