FLOWER ORDER FORM

VASE ARRANGEMENT OPTIONS

PLEASE SELECT AN OPTION:

ANY SPECIFIC NOTES?

WOW FACTOR CURATED ARRANGEMENTS

PLEASE SELECT AN OPTION:

ANY SPECIFIC NOTES?

BOUQUET OPTIONS

PLEASE SELECT A SIZE:

Would you like to add a vase to your bouquet?

FLORAL BASKETS

PLEASE SELECT AN OPTION:

ANY SPECIFIC NOTES?

NATIONWIDE DELIVERY OPTIONS

We also offer nationwide overnight delivery for our custom designed burlap bouquets. Shipping fee is subject to the delivery zip code and ranges anywhere from $12 (in New York) to $45 (to California on a Saturday), for example.

	Designer Choice Bouquet w/Burlap & Ribbon - $85
	Add a vase - $20

ADDITIONAL INFORMATION & SUBSCRIPTION SIGN UP

Any specific requests or needs?

Would you like to include a message with your flowers?

RECIPIENT CONTACT INFORMATION

Recipient First Name *

Recipient Last Name *

Recipient Street Address *

Recipient City *

Recipient State *

Recipient Zip Code *

Recipient Phone Number *

Recipient Email Address *

PURCHASER BILLING & CONTACT INFORMATION

Purchaser First Name *

Purchaser Last Name *

Purchaser Zip Code *

Purchaser Phone Number

Purchaser Email Address *

PICK UP OR DELIVERY?

DATE: * +

OPTIONS ARE: *

PICK UP AT THE STORE - NO CHARGE

LOCAL DELIVERY $15 (North Salem area)

REGIONAL DELIVERY $25 (12 miles +) afternoons only

NATIONWIDE DELIVERY - TBD

SPECIAL INSTRUCTIONS?

Local Pick Up or Delivery Time: *

Between 9am - 12pm

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

Billing Information: We charge a 4% processing fee along with Westchester County 8.375%. tax.

Card Number: *

Credit Card Type *

Expiration Date (mm/yy) *

CVV: *

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