SECTION 1 – Customer Information (print clearly or type)
Company:
Name:
Address:
City:	State:	Zip:
Phone No.:	Fax No.:
E-mail:
SECTION 2 – Order Information
Quantity Needed	Description (Kind of Trees, Seed or Package)	Price Per Unit	Total Item Cost
Ball Cap, Embroidered, Cotton Twill	$13.00 each
Banner, Vinyl (3 ft. x 4 ft.)	$90.00 each
Counter Card, Easel Back (8.5 in. x 11 in.)	$9.00 each
Informational Brochures (50/pack)	$7.50 pack
Logo Decals, Oval Vinyl (10/pack)	$5.00 pack
Logo Price Stickers (100/roll)	$7.50 roll
Tattoos, Temporary (50/pack)	$5.00 pack
T-shirts, White, Size Medium	$10.00 each
T-shirts, White, Size Large	$10.00 each
T-shirts, White, Size X-Large	$10.00 each
T-shirts, White, Size XX-Large	$11.00 each
Virginia Grown High-Resolution Logo (will be emailed to you at no charge)	$0.00 each
Subtotal:
Sales Tax (5.3% of Order Subtotal) [Tax-exempt orders must submit a completed sales tax exemption (i.e. ST-18; blank sales tax exemption forms can be found at tax. Virginia.gov).]
Shipping (add $1.00 per item):
Total Amount Due (Payment must be enclosed at the time of order):
Refunds within 30 days, with receipt, excluding all shipping and handling charges. Make check payable to "State Forester".
SECTION 3 – Use Agreement
The program is open to any business that uses or sells Virginia Grown forest products. By using Virginia Grown marketing and promotional materials, you agree to use the Virginia Grown materials for promotion of Virginia Grown products only and understand that use of materials can be revoked if misused.
User Name (Print)	User Signature	Date
Mail Order Form and Payment To:	Virginia Department of Forestry – Virginia Grown Program 900 Natural Resources Drive, Suite 800 Charlottesville, VA 22903	Phone: (434) 220-9021 Fax: (434) 296-2369