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MAIL ORDER FORM

Please type all information on the form below and then print the form.

Please provide the following ordering information - Incomplete or inaccurate information will delay the processing of your order.
ITEM QTY ITEM #  &  SHORT DESCRIPTION UNIT PRICE
($ Each)		 ITEM
SUBTOTAL

SUB-TOTAL

SALES TAX (NE ONLY ADD 7%)

SHIPPING CHARGE 
(ADDITIONAL CHARGE FOR EXPRESS, HEAVY, & BULKY ITEMS)

$9.99

GRAND TOTAL

BILLING
Credit Card Type Visa Mastercard Discover Am Express
Name On Card
Card Number
Expiration Date
Card Billing Address
Name
Street Address
Address (cont.)
City
State
Zip/Postal Code
Phone
E-Mail
Shipping Address
Name
Street Address
Address (cont.)
City
State
Zip/Postal code
Phone
Choose one of the following options
Would you like your purchases professionally gift wrapped or gift bagged? 
(A $6.99 charge will apply for each item.)
If you checked yes for the gift wrapping. Please tell us below how you would like the brief personal note to read.
Print this page and Fax to 402-344-3659 or Mail it to:

Premium Home and Garden
6622 South 118th Street
Omaha, NE 68137

If you provide an e-mail address, we will confirm your order within 24 working hours.

Please retain a copy of this order for your records.
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Customer Care & Store Hours: 
Monday-Thursday 10am - 5:30pm (CST) 
Friday - Saturday 10am - 7pm (CST) 
Sunday Noon - 5pm (CST)

Phone: Within US 877-541-4076   In Nebraska or Outside of US 402-344-3536

Located just off Harrison Street * Harry Anderson Ave.
 6622 South 118th Street - Omaha, NE  68137

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