To Register as a member of The Potting Shed's Preferred Customer Club,
please print this page and fax (978-369-1416) or mail (Box #1287 Concord, MA 01742) the completed form to The Potting Shed. If more
convenient for you, call us (978-369-1382) and we will complete your registration over the telephone.
Your Name_______________________________________________________________
Street
Address____________________________________________________________
POB Box#__________________________ Apt/Bldg#____________________________
City________________________________
State_______ Zip Code_______________
Daytme Telephone #_______________________________
Fax #___________________________________________
E-mail
Address ___________________________________
One Yr. Membership @ $30.00
Five Year Membership @ $100.00
Paymnet method:
Check
VISA Mastercard Discover
Card American Express Card
Credit card #____________________________
Expires____/____ V Code_________
