Dacs-11206 - Tree Seedling Order Form - Florida Department Of Agriculture And Consumer Services, Florida Forest Service
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1
2Florida Department of Agriculture and Consumer Services
Make Check or Money Order
Florida Forest Service
Payable To:
Andrews Nursery (352) 493-6096
Florida Department of Agriculture and
Consumer Services
TREE SEEDLING ORDER FORM
Mail This Order Form With Payment
To:
ADAM H. PUTNAM
Chapter 589.11(2),F.S.
Andrews Nursery, Florida Forest Service
COMMISSIONER
P.O. Drawer 849
Chiefland, Florida 32644
CUSTOMER INFORMATION
ORDER NO:
-
Name________________________________________________
I will pick up my seedlings at Andrews
(Last)
(First)
(M.I.)
Nursery. No Delivery Cost.
Address_______________________________________________
I wish to have my seedlings delivered to
the following FFS delivery point.
Delivery
City_________________________State_______Zip____________
Costs Apply. See Brochure for options.
Phone_(____
)_________________(____
)_______________
Daytime
Evening
______________________
Contact Person____________________(
)____________
Delivery Point
(If different from above)
Contact Phone
Type of Land Ownership (Check one)
I will notify the nursery at a later date
1. Federal
4. State Forest
7. Other Industry
when I wish to receive my seedlings. Please
2. Private
5. Other State Lands
give 5 working days notice for both pickups
and deliveries.
3. Forest Industry
6. Other Government
COUNTY___________________________
I have indicated a date for pickup or
(
Where seedlings will be planted)
delivery below.
QUANTITY
UNIT
SEEDLING
DELIVERY COST
Pickup or Delivery
SEEDLING TYPE
ORDERED
COST
COST
(If applicable)
Date: mm/dd/yy
$
$
$
/
/
$
$
$
/
/
$
$
$
/
/
$
$
$
/
/
$
$
$
/
/
$
$
$
TOTAL SEEDLING
TOTAL DELIVERY
GRAND
COST
COST
TOTAL
OFFICE USE ONLY
OFFICE USE ONLY
Received By________________________________
42-11-____-____-_____ ____(EO)
Date Received_______________________________
009021
009026
Check or M.O. Number_______________________
Issue Date__________________________________
DACS-11206 Revision 06/2006
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