State Form 46766 - Dnr Tree Seedling Order

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DNR TREE SEEDLING ORDER
State Form 46766 (R17 / 7-15)
Instructions: Please print or type in black ink.
(Customer Billing Address)
First Name
Last Name
Address
City
State
ZIP
County where trees will be planted
Email:
Telephone No. (
)
Tax Exemption
(Please Attach Completed Indiana State Tax Exempt Form.)
Choose only 1 of the 3 methods listed below for receiving your order and complete approriate information:
1.
Pick up:
Vallonia
Jasper-Pulaski
(Check One)
2.
UPS shipping
UPS WILL NOT SHIP TO A P.O. BOX, (SEE UPS RATE IN THE IMPORTANT INFORMATION SECTION.)
First Name
Last Name
Address
City
State
ZIP
3.
3rd Party Pick up
Vallonia
(Complete one and check the nursery where trees will be picked up
.)
Jasper-Pulaski
Consultant Forester
County Agency
Name
Name
Telephone No. (
)
County
Telephone No. (
)
NOTE: MINIMUM ORDER IS 100 SEEDLINGS PER SPECIES OR 1 PACKET.
SELECT LINE MINIMUM IS 50 SEEDLINGS.
1ST
QUANTITY
2ND
3RD
4TH
1ST
2ND
3RD
4TH
QUANTITY
CHOICE
CHOICE
CHOICE
CHOICE
CHOICE
CHOICE
CHOICE
CHOICE
CODE
CODE
CODE
CODE
CODE
CODE
CODE
CODE
8
100
21
* Example
Only
*EXAMPLE SHOWS AN ORDER FOR 100 WHITE PINE 3 YEAR AS 1st CHOICE AND WHITE PINE 2 YEAR AS 2nd CHOICE.
Cut on dotted line before mailing or faxing order.
Select Line
Selections made from phenotypically superior parent trees. Selections made due to their superior growth and form characteristics.
Parent trees are contained in thinned orchards.
In the event of a crop failure species may be substituted.
GUARANTEE
Seedling losses can result from adverse weather and many other causes beyond our control therefore we do not guarantee seedling survival
unless we determine that losses occurred due to our handling procedures. If seedling losses occur after planting, please contact us within
the first thirty (30) days so that the cause can be determined.
Information concerning the mature size and recommended use of these species can be obtained by contacting either nursery or from the
“Tree Species Information” on our website at
DO NOT PLANT UNDER POWER LINES.

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