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 ___________

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