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PLEASE
PROVIDE THE FOLLOWING INFO: |
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PURCHASER
INFORMATION: |
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Contact
Name |
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Contact
last name |
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Florist
Name |
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Address |
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City |
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State/Province |
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Zip/Postal
Code |
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Country |
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Business
Phone |
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Home
Phone |
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Cell
Phone |
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E-mail |
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RECIPIENT
INFORMATION: |
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CLICK
IF SAME AS PURCHASER AND SKIP THIS SECTION |
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Full
Name |
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Address |
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City |
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State/Province |
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Zip/Postal
Code |
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Country |
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Business
Phone |
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Home
Phone |
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Cell
Phone |
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E-mail |
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FILLERS SELECT TYPE, SIZE AND QUANTITY - EACH
BUNCH CONTAINS 10 STEMS |
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ALSTILBE
ASSORTED: |
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QTY.
BUNCHES: |
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ASTER
WHITE: |
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QTY.
BUNCHES: |
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ASTER
PURPLE: |
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QTY.
BUNCHES: |
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ASTER
MONTECASINO: |
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QTY.
BUNCHES: |
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ASTER
SOLIDAGO: |
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QTY.
BUNCHES: |
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ALSTROMELIA: |
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QTY.
BUNCHES: |
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BABY
BREATH: |
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QTY.
BUNCHES: |
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LILIS
ORIENTALES: |
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QTY.
BUNCHES: |
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LILI
STARGEZER: |
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QTY.
BUNCHES: |
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DELPHINIUM
ASSORTED: |
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QTY.
BUNCHES: |
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GERBERAS: |
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QTY.
BUNCHES: |
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LILI
CASABLANCA: |
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QTY.
BUNCHES: |
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GLADIOLOS: |
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QTY.
BUNCHES: |
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HYDRANGEAS: |
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QTY.
BUNCHES: |
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HYPERICUM: |
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QTY.
BUNCHES: |
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IRIS
ASST: |
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QTY.
BUNCHES: |
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LIATRIS: |
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QTY.
BUNCHES: |
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LARKSPUR: |
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QTY.
BUNCHES: |
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LILI
DEL VALLE: |
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QTY.
BUNCHES: |
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LIMONIUM: |
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QTY.
BUNCHES: |
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LEATHER
LEAF: |
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QTY.
BUNCHES: |
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LISIANTUS: |
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QTY.
BUNCHES: |
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MATSUMOTO: |
N.A. |
QTY.
BUNCHES: |
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MILLION
STAR: |
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QTY.
BUNCHES: |
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LILIS
ASIATICAS ASST: |
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QTY.
BUNCHES: |
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SNAP
DRAGON: |
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QTY.
BUNCHES: |
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STATICE
ASST: |
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QTY.
BUNCHES: |
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STARS
OF BELEN: |
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QTY.
BUNCHES: |
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BELLS
OF IRELAND: |
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QTY.
BUNCHES: |
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SPRAY
ROSES: |
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QTY.
BUNCHES: |
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QUEEN'S
LACE: |
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QTY.
BUNCHES: |
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TUBEROSAS: |
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QTY.
BUNCHES: |
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CAMPANOLA: |
N.A. |
QTY.
BUNCHES: |
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PEONIAS: |
N.A. |
QTY.
BUNCHES: |
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FRESSIA
ASST: |
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QTY.
BUNCHES: |
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COMMENTS |
DELIVERY
DATE |
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FOLIAGE
- GREENS SELECT TYPE, SIZE AND QUANTITY |
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BEAR
GRASS: |
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QTY.
BUNCHES: |
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CURLY
WILLOW: |
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QTY.
BUNCHES: |
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ASPIDRISTA: |
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QTY.
BUNCHES: |
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ITALIAN
RUSCUS: |
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QTY.
BUNCHES: |
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IVY: |
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QTY.
BUNCHES: |
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JADE: |
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QTY.
BUNCHES: |
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LEATHER
LEAF: |
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QTY.
BUNCHES: |
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PITTOSPORUM: |
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QTY.
BUNCHES: |
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PLUMOSO: |
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QTY.
BUNCHES: |
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ESMERALDA: |
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QTY.
BUNCHES: |
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TREE
FERN: |
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QTY.
BUNCHES: |
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SALAL
TIP: |
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QTY.
BUNCHES: |
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SALAL
LARGE: |
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QTY.
BUNCHES: |
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SPRENGERII: |
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QTY.
BUNCHES: |
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GALAX: |
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QTY.
BUNCHES: |
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EUCALIPTO
SILVER DOLAR: |
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QTY.
BUNCHES: |
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EUCALIPTO
BLUEGUM: |
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QTY.
BUNCHES: |
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EUCALIPTO
BABY BLUE: |
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QTY.
BUNCHES: |
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EUCALIPTO
SEEDED: |
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QTY.
BUNCHES: |
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COMMENTS |
DELIVERY
DATE |
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| PAYMENT
INFORMATION (Delivery and Florida taxes charges apply) |
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Credit
card |
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Cardholder
Name |
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Card
Number |
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Expiration
Date |
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(MM/YY) |
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SPECIFY
ANOTHER
PAYMENT METHOD: |
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CASH
ON DELIVERY: |
MONEY
ORDER: |
CASH
CHECK: |
CASH
IN ADVANCE: |
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OTHER:
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PLEASE
SPECIFY |
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We
will contact you via e-mail or phone shortly with your order
confirmation |
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Please
verify your information carefully before submitting for
ordering |
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