PLEASE PROVIDE THE FOLLOWING INFO:

Contact Name   

Contact last name   

Florist Name   

Address   

City   

State/Province   

Zip/Postal Code   

Country   

Business Phone   

Home Phone   

Cell Phone   

E-mail    

RECIPIENT INFORMATION:

CLICK IF SAME AS PURCHASER AND SKIP THIS SECTION 

Full Name   

Address   

City   

State/Province   

Zip/Postal Code   

Country   

Business Phone   

Home Phone   

Cell Phone   

E-mail    

EXOTIC FLOWERS SELECT TYPE, SIZE AND QUANTITY - EACH PACK CONTAINS 25 OR SPECIFIED

AGAPANTHUS:   

QTY. BUNCHES:   

ANTURIOS:   

QTY. BUNCHES:   

BASTON DEL AMARADOR:   

QTY. BUNCHES:   

BIRD OF PARADISE:   

QTY. BUNCHES:   

GERBERAS ASST:   

QTY. BUNCHES:   

GINGER RED/PINK:   

QTY. BUNCHES:   

HELICONIAS:   

QTY. BUNCHES:   

HYDRAGEAS:   

QTY. BUNCHES:   

KANGAROO POWS:   

QTY. BUNCHES:   

LEUCADENDRONS:   

QTY. BUNCHES:   

MINI PINEAPPLE:   

QTY. BUNCHES:   

PINEAPPLE:   

QTY. BUNCHES:   

PROTEAS:   

QTY. BUNCHES:   

ROSTRATA:   

QTY. BUNCHES:   

SUNFLOWERS:   

QTY. BUNCHES:   

COMMENTS

DELIVERY DATE

ORCHIDS SELECT TYPE, SIZE AND QUANTITY - EACH PACK CONTAINS 25 OR SPECIFIED

ESUMI (DARK LAVANDER):   

QTY. BUNCHES:   

FARTIMA (YELLOW GREEN):   

QTY. BUNCHES:   

JADE (GREEN):   

QTY. BUNCHES:   

KATING DANG:   

QTY. BUNCHES:   

MOCARA RED:   

QTY. BUNCHES:   

MOKARA BOON (BRIGHT RED:  

QTY. BUNCHES:   

MOKARA CALYPSO PINK:   

QTY. BUNCHES:   

MOKARA JITI (YELOW):   

QTY. BUNCHES:   

MOKARA (PANNEE):   

QTY. BUNCHES:   

MOKARA PINK:   

QTY. BUNCHES:   

MS. TEEN (PINK):   

QTY. BUNCHES:   

RAMSEY (YELLOW):   

QTY. BUNCHES:   

SENSATIONAL PURPLE:   

QTY. BUNCHES:   

SONIA:   

QTY. BUNCHES:   

WHITE:   

QTY. BUNCHES:   

COMMENTS

DELIVERY DATE

POMPONS SELECT TYPE, SIZE AND QUANTITY - EACH BUNCH CONTAINS 10 STEMS

BUTTON ASST:   

QTY. BUNCHES:   

C/D/N:   

QTY. BUNCHES:   

CREMON ASST:   

QTY. BUNCHES:   

CUSHION ASST:   

QTY. BUNCHES:   

DAISY ASST:   

QTY. BUNCHES:   

DISBUD:   

QTY. BUNCHES:   

FUJI:   

QTY. BUNCHES:   

MICROPOMPON ASST:   

QTY. BUNCHES:   

MUMS:   

QTY. BUNCHES:   

SPIDER DELISTAR:   

QTY. BUNCHES:   

VICKING:   

QTY. BUNCHES:   

CREMON:   

QTY. BUNCHES:   

CRISANTREMO:   

QTY. BUNCHES:   

COMMENTS

DELIVERY DATE

CARNATIONS SELECT TYPE, AND QUANTITY - EACH BUNCH CONTAINS 25 STEMS

CARNATION ASST:   

QTY. BUNCHES:   

CARNATION NOVELTY:   

QTY. BUNCHES:   

CARNATION RED:   

QTY. BUNCHES:   

CARNATION WHITE:   

QTY. BUNCHES:   

MINICARNATION ASST:   

QTY. BUNCHES:   

MINICARNATION NOVELTY:   

QTY. BUNCHES:   

MINICARNATION WHITE:   

QTY. BUNCHES:   

MINICARNATION RED:   

QTY. BUNCHES:   

COMMENTS

DELIVERY DATE

Credit card   

Card Number    

Credit Card Secure Code    

Cardholder Name   

Cardholder Billing Address   

Expiration Date   

(MM/YY) 

SPECIFY ANOTHER PAYMENT METHOD:   

CASH ON DELIVERY:  

MONEY ORDER:  

CASH CHECK:  

CASH IN ADVANCE:  

OTHER:  

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