To charge Seed Bank orders to your credit card you must

1. Print out this form on a separate piece of paper from your seed order.
2. Fill this form in completely.
3. Mail this form with your seed order.

* If you can't print this form, we need all this information on a separate piece of paper.
* If you check "No Substitutions" on the seed order form and the item is
    out of stock, you will be charged only for what is actually shipped.

Amount Authorized	US$___________________	I need the charge receipt     (will delay shipping)
Type of Card	Visa         Master Card
Card Number
Expiration Date	/
Your Name	_________________________________________________________
E-mail address	_________________________________________________________
Name on Card if different	_________________________________________________________
Signature of Cardholder	_________________________________________________________
Billing Address of Cardholder	_________________________________________________________
	_________________________________________________________
	_________________________________________________________

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