ScapeForm

Print and complete this form and mail check or money order to:

Juniata Stinking Rose

719 Washington Ave.

Mifflintown, PA 17059


	SCAPES ORDER FORM

Name:_________________________________________ Address:_______________________________________ City/State/Zip:__________________________________ Phone:________________________________________
TYPE	AMOUNT (in pounds)
SCAPES
Total (pounds)
Cost per pound ( $5 before June 1, 2001) ___ X $5
Shipping and handling $3.50 1st. lb. $1.50 each additional lb.
Total $


	Send Check or Money Order with this form to: Juniata Stinking Rose 719 Washington Ave. Mifflintown, PA 17059