HOME      Living Vine PRINT & MAIL ORDER FORM / CALL 757-880-6212     E-Mail 

Name
Address

Phone (W)                                                                  (H)

QTY

COLOR

ITEM

SIZE

PRICE

TOTAL

*S&H $1/item each additional item

 Subtotal
VA Tax (Sub Total x 1.05)
S&H $7.95*
TOTAL

Make check payable to:  Living Vine / Mail to: 524 Woodland Rd., Hampton, VA  23669

VISA – Master Card – Discover

Charge Card Purchase:  Fill in 16 Digit Number w/ Expiration Date & Sign below.

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