From:
|
|
|
| Your Name: |
________________________________ |
| Your Phone #: |
________________________________ |
| Your Fax #: |
________________________________ |
| Today's Date: |
________________________________ |
| Time: |
________________________________ |
| |
|
| To: |
________________________________ |
Date of Delivery:
|
________________________________ |
| Name of Recipient: |
________________________________ |
| Recipients Phone: |
________________________________ |
Recipient Address
City, State, Zip Code: |
________________________________________________________________ |
| |
|
|
Items to Send:
(please enter the $ amount on appropriate line -
*Tax and delivery not included in pricing listed) |
| $_________ |
Fresh Cut Flowers in Vase ($40 & up) |
| $_________ |
Tropical Flowers in Design Tray ($60 & up) |
| $_________ |
Desk Planter - Dish Garden ($60 & up) |
| $_________ |
Office / Home Floor Plant - 3 to 6 ft. ($75) |
| $_________ |
Funeral / Sympathy Arrangement ($100 & up) |
| $_________ |
Orchid Plant - 6" pot ($65) |
| Card #: |
__________________________________ |
|
| Exp. Date: |
________ |
|
| Business Name: |
_______________________________________________ |
| Zip Code: |
________________ |
|
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