FLOWER ORDER FORM

VASE ARRANGEMENT OPTIONS

PLEASE SELECT AN OPTION:

ANY SPECIFIC NOTES?

PLEASE SELECT AN OPTION:

ANY SPECIFIC NOTES?

PLEASE SELECT A SIZE:

Would you like to add a vase to your bouquet?

PLEASE SELECT AN OPTION:

ANY SPECIFIC NOTES?

Any specific requests or needs?

Would you like to include a message with your flowers?

Recipient First Name *

Recipient Last Name *

Recipient Street Address *

Recipient City *

Recipient State *

Recipient Zip Code *

Recipient Phone Number *

Recipient Email Address *

Purchaser First Name *

Purchaser Last Name *

Purchaser Zip Code *

Purchaser Phone Number

Purchaser Email Address *

DATE: deliveries only Tuesday - Friday * +

OPTIONS ARE: *

PICK UP AT THE STORE - NO CHARGE

LOCAL DELIVERY $20.08 (North Salem area, Tuesday - Friday)

REGIONAL DELIVERY $31.20 (12 miles +) afternoons only

Local Pick Up or Delivery Time: *

Between 12pm - 2pm

After 2pm

Extra Notes: Call Ahead? Leave at the Front Door? Leave in the Heated Garage?

Current Total (tax will be added at time of purchase of 8.375%):

$0.00

Card Number: *

Credit Card Type *

Expiration Date (mm/yy) *

CVV: *

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