World Paulownia Institute

Order Form for International Orders

Name / Company:     ______________________________________

Contact Person:        ______________________________________

Phone Number:         ______________________________________

Fax Number:               ______________________________________

Email Address:           ______________________________________

Shipping Address:    ______________________________________

                                        ______________________________________

Destination Port:       ______________________________________

Do you have a history with the Department of Ag?    ___________

Do you currently hold an import permit of any sort? ___________

Payment Details – wire transfer or credit card:     ________________

For a wire transfer please email for wiring details.

For a credit card we accept Visa, Master Card, and Discover.

                Credit Card Type:           _________________________

                Credit Card Number:     _________________________

                Expiration Date:             _________________________

                Billing Address:             _________________________

                                                        _________________________

Anticipated Delivery Date:       _________________________

The minimum order is 5000 tissue cultures.

There are 30 plants per container.

Mixed Varieties Available.

Paulownia Varieties Available:

             Paulownia Elongata:         ____________________

             Paulownia Catalpafolia:   ____________________

             Paulownia Fortunei:         ____________________

Please fax the completed order form to 1 - 229 - 546 - 4564

If you have any further questions please email wpi@worldpaulownia.com