United States Order Form - Page 1
(Use the Print Function of your Browser to copy this Form )

Please print out this order form, make entries, and mail both pages to:
Lyndon Lyon Greenhouses, Inc. - PO Box 249 - Dolgeville, NY 13329
Date:________________
ORDERED BY:

Name:__________________________________

Address1:_______________________________

Address2:_______________________________

City:___________________________________

State:__________________ Zip:_____________

Home Phone # __________________________

Work Phone # __________________________

E-mail: ________________________________

Have you ordered from us before? ____Yes ____No

$__________ Total from page 2

$__________ Packing & Handling Charge
(.25 cents per plant)
Shipping charges (Please choose your carrier):

$__________ UPS Ground Service

$__________ UPS 2nd Day Air Service

$__________ USPS Priority Mail

$__________ Subtotal

$__________ New York State Sales Tax
(N.Y. residents only!)

$__________ Total enclosed


You can also FAX these forms to us at:
#315-429-3820

 Fill out only if shipping to a different address:
SHIP TO:

Name:_________________________________

Address1:______________________________

Address2:______________________________

City:__________________________________

State:__________________ Zip:____________

Please indicate method of payment:

__Check __Money Order __Mastercard __Visa


For Credit Card Orders only:

Card # _______ / _______ / _______ / _______

Expiration Date: ______ / _______

Security Code: _____ (3 numbers on back of card)

Signature:_______________________________

If we are out of varieties you have selected, should we:
___ Not Substitute
___ Substitute with Lyon's Choice
___ Substitute with the following:
_____________________________________
_____________________________________
_____________________________________
(If no indication is made, we will substitute, or issue credit.)

Office use only:

Packed by: _________________ Date: ________

RETURN TO FORMS PAGE