Shields Gardens Ltd.
P.O. Box 92
Westfield, IN 46074
U.S.A.

Clivia Order Form

First name:
Last name:
Address:
City:
State:
Postal code:
Country:
Telephone:
E-mail address:
Payment method:
  • VISA
  • MasterCard
  • Check in US Dollars on a US bank
  • Money Order in US Dollars on a US bank
Card number:
Expiration date:
Verification Code:*
(*Last three digits in signature box on back of card.)
Quantity Catalog No. Name of Item Unit Cost Total
Subtotal
Total from other pages
Sales Tax if Indiana(7%)
Shipping
Total

You can fill out this form on screen, but then please print it out and mail it to us. Thank you.
Shields Gardens Ltd.
P.O. Box 92
Westfield, IN 46074
USA

We accept VISA Orders: 1-866-449-3344 Toll-free We accept MasterCard