ALCOVY DAYLILY FARM ONLINE REQUEST FORM
Column # 1
**  Qty of Free
Plants
 **
(Only enter Qty. if item is
"Buy 2 Get 2 Free")
Plants are reserved
after payment is
received
Mail check to:
Jesse Burgess
P.O. Box 1753
Covington, GA
30015

(770)787-7177
Column # 2 Qty of
Plants you're buying
Make Check Payable to: Jesse Burgess
Multiply
"Qty." by
"Price Each"
1
2
Ext. Price
Cultivar
Price Ea
Sub-total
(Remember, if you are picking up your
order, omit the $10.00 Shipping and the
per plant handling charge).
(GA Residents Only)
7% Sales Tax
$10.00
Shipping Charge
Total Plants
To Ship
( Multiply by $1.00 )
Handling Charge
Make check payable to: Jesse Burgess
TOTAL