ORGANIC HARVEST PLUGS
540 Rocky Point Road
East Marion, NY 11939
Fax: (631) 333-2415
Phone: (844) BE-ORGANIC
[email protected]
CUSTOMER INFORMATION
Customer Name:__________________________________________________
Phone #: ________________________________________________________
Fax #: ___________________________________________________________
Email: ___________________________________________________________
Shipping Address:
________________________________________________________________
Billing Address:
_________________________________________________________________
Credit Card #: ____________________________________________________
Credit Card Expiration Date: _______________
CVC#: ________________
Notes: __________________________________________________________
______________________________________________________________________
______________________________________________________________________
Return along with the ORDER FORM page to: (631) 333-2415 (FAX) or
[email protected]