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Order Date:
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BOUQUET INFORMATION: |
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Type of occasion:
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__________________________________________ |
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Delivery Date:
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__________________________________________ |
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Type of Arrangement:
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__________________________________________ |
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Special Request:
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__________________________________________ |
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Message:
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__________________________________________ |
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__________________________________________ |
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__________________________________________ |
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(If further space is needed,
please use separate piece of paper.) |
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DELIVERY
INFORMATION: |
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| Name: |
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__________________________________________________ |
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Address1: |
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__________________________________________________ |
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Address2: |
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__________________________________________________ |
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City: |
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__________________________________________________ |
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State: |
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_______________ Zip:
____________________ |
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Telephone: |
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________________________ (required for delivery) |
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SENDER'S
INFORMATION: |
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Name: |
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__________________________________________________ |
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Address1: |
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__________________________________________________ |
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Address2: |
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__________________________________________________ |
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City: |
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__________________________________________________ |
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State: |
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_______________ Zip:
____________________ |
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Telephone: |
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________________________ (required) |
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Upon receipt of your fax, we
were call to confirm order and payment options.
Credit Cards are NOT accepted. |