Subscription form for the Verti-Gro newsletter Name:__________________________________________ Address:_______________________________________ _______________________________________________ _______________________________________________ Phone:_________________________________________ Fax:___________________________________________ E-mail address:________________________________ Web Site URL:__________________________________ If the business address is different from above: Business address:______________________________ _______________________________________________ _______________________________________________ Type of business:______________________________ Size of greenhouse:____________________________ Size of farm:__________________________________ Crops grown:___________________________________ How long in business at this address:__________ Are you a home gardener?: Y / N Your special interests: Hydroponics __ Organic gardening __ Soilless gardening __ Greenhouse __ Other __ What?_________ Method of payment: MC __ VISA __ AMEX __ Discover __ Check or MO __ If by check, check number:_____________________ If by credit card, card holder's name: _______________________________________________ Card number:___________________________________ Expiration date:_______________________________ You can fax this to us at: 352 347-9877 Or mail it to us at: Verti-Gro Newsletter subscription 15000 SE Hwy 441 Summerfield, FL 34491