Simplify Ordering!
Call
(919) 872-9999 or 1-888-921-3344
Fax your order to us at 919-872-9925
Please Print Clearly!
|
Simplify Ordering! |
|
Sender's Name:_______________________________________________________________________
Credit Card Billing Address :_____________________________________________________________
City:___________________________________________State:__________________Zip:___________
Phone # (required):_____________________________________Fax:___________________________
Email Address (PRINT CLEARLY): ______________________________________________________________________
| Payment Method | 
MC/Visa
AMEX
Discover |
|
House Account (Application must be received 15 Days prior
to ordering) |
|
Card # ___________-____________-____________-_______________ Ex:________ |
|
| Credit Card billing address REQUIRED for Internet orders for security purposes | |
Occasion (Birthday, Get Well, New Baby...)_________________________________________________
Size/Type (Reg, Bouquet, Long Stem, Cookie Lover's Dream)____________________________________
Bouquet is for:
Woman
Man
Girl
(age)____
Boy (age)____
Group (Men and Women)
If applicable, additional
treat:
Coffee
Lindt Chocolate/Jelly Beans (in Summer)
Teddy Bear and Choc Bars or M&M's
Enclosure Card: _______________________________________________________________________
_____________________________________________________________________________________
From:________________________________________________________________________________
Date to Arrive ___________________
Deliver/Ship to:
Name: _________________________________________ Company: __________________________________
Phone # (required):_____________________________________
Address: ______________________________________________________Suite/Apt_______________
City: ___________________________________________________ State: _____________Zip________
Would you like an email
response to this fax?
Yes
No
Thank You Please go to our homepage and bookmark it.