Maple Valley Orchards and Nursery 11541 Claywood Road Gillett, WI 54124 Phone 920-842-2904 Fax: 920-842-3204 sales@maplevalleyorchards.com Name _____________________________________________________________ Address __________________________________________________________ City ___________________________ State ____________ Zip___________ Phone Number (___) _________________ Ship Date __________________ UPS SHIPPING ADDRESS (if different from above) Name ______________________________________________________________ Address ___________________________________________________________ City ___________________________ State ____________ Zip ___________ If using Visa or Mastercard: Exp. Date: ________|_________|_________ Charge Card Account No. __________-___________-__________-_________ Name on Card ______________________________________________________ Signature _________________________________________________________ If using check: Check# ____________________________________________ Please list acceptable alternate varieties and rootstocks.. Type - Bareroot (BT), Benchgraft (BG), Quantity or Scionwood (S) Variety and Rootstock Alternative Variety Each Total [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] [_____] [_______] [______________________________] [______________________________] [________] [________] Sub-Total: [________] Shipping: [________] Sales Tax: [________] (WI - 5.5%) Total: [________]