HELEN'S DAHLIAS
6813 N.E. 139TH ST.
VANCOUVER, WA 98686
(360)573-8249

DATE ______________  NAME _____________________________________________________________

STREET/BOX NO.________________________________________________________________________

CITY__________________________________ STATE____________________ ZIP ___________________

APRIL 1ST DELIVERY DATE?   YES OR NO ____________  PREFERED DATE  ______________________

REMITTANCE ENCLOSED:  MONEY ORDER $_____________  CHECK $ ___________________________

WILL YOU ACCEPT AN EQUAL OR BETTER VARIETY?  YES OR NO _______________________________

DO YOU WANT A POST CARD SENT FOR YOUR ORDER AT YOUR EXPENSE?  YES OR NO ___________

..QUANTITY..	..$ TUBER..	CODES...........VARIETY....................	..TOTAL $..
		TAX
		SHIPPING
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