To reserve your space, print out this page, fill out the form, and mail your payment to:

HartleyBotanica, Inc.
P.O. Box 1338
Somis, Ca 93066

BRIDE: _________________________________________

GROOM: _______________________________________

ADDRESS: ______________________________________

CITY / STATE / ZIP: ______________________________________

PHONE: ________________________________________

EMAIL: ______________________________________

WEDDING DATE: _______/_______/__________

# OF GUESTS FOR THE WEDDING: _______________

# TO ATTEND OPEN HOUSE: _______ X $8 per person = __________

Enclosed is my:

____ Check

____ Credit card number

BILLING NAME: ___________________________________

_______-_______-_______-_______ EXP. _____/_____

Billing Address Zip Code: ________________