Hoya Plants Mail Order Form 

Please fill out and print this form. Send it with your payment:

Full  Name: _______________________________________________________

Street Address:   ___________________________________________________

City/ State/ Zip:    ___________________________________________________

Telephone Number:    ________________________________________________

Email Address:    ___________________________________________________

Fees paid by Check _____ Money Order _____ Cash ______

Your Check or Money Order should be made payable to Arlene Jacobs.