ORDER FORM             MIDWAY NURSERIES LTD
DELIVERY ADDRESS               INVOICE ADDRESS

Title & Forename ............................     Title & Forename............................

Surname...........................................     Surname .........................................

Address ...........................................     Address ..........................................

..........................................................      .........................................................

..........................................................      .........................................................

Postcode .........................................     Postcode .........................................

Telephone Number ...................................................................

              PLEASE COMPLETE IN BLOCK CAPITALS

Thank you for your details which WILL NOT be shared by third parties

      EASE SEND YOUR ORDER TO HEAD OFFICE :-

               31 Burslem Close, Turnberry Estate, Bloxwich, WS3 3YD 

  FREE POSTAGE AND PACKAGING WITH ORDERS OVER £70

Plant Type           Plant Variety               Quantity                    Item Cost

                                                                                 Sum Total                                                         

Please include with your order payment by cheque or postal

                 order made payable to Malcolm Jones