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RECIPIENT INFORMATION:

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Full Name   

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PINK ROSES SELECT TYPE, SIZE AND QTY - EACH BUNCHE CONTAINS 25 ROSES 

ANNA:   

QTY. BUNCHES:   

CHARMING UNIQUE:   

QTY. BUNCHES:   

CRAZY ONE:   

QTY. BUNCHES:   

ELISA:   

QTY. BUNCHES:   

ESPERANCE (x 12 STM):   

QTY. BUNCHES:   

LIVIA:   

QTY. BUNCHES:   

PINK INTUITION:   

QTY. BUNCHES:   

PINK OSIANA:   

QTY. BUNCHES:   

PRICELESS:   

QTY. BUNCHES:   

ROSSINI:   

QTY. BUNCHES:   

SILVER PINK:   

QTY. BUNCHES:   

SOPHIE:   

QTY. BUNCHES:   

SWEET SHOT:   

QTY. BUNCHES:   

SWEET UNIQUE:   

QTY. BUNCHES:   

TITANIC:   

QTY. BUNCHES:   

VANITY:   

QTY. BUNCHES:   

VOGUE:   

QTY. BUNCHES:   

WILD ONE:   

QTY. BUNCHES:   

MEDIUM PINK ROSES SELECT TYPE, SIZE AND QTY - EACH BUNCHE CONTAINS 25 ROSES 

ATTACHE:   

QTY. BUNCHES:   

BIG FUN:   

QTY. BUNCHES:   

LATIN BREEZE:   

QTY. BUNCHES:   

ORLANDO:   

QTY. BUNCHES:   

PANAMA:   

QTY. BUNCHES:   

PAVAROTTI:   

QTY. BUNCHES:   

ROSITA VENDELA:   

QTY. BUNCHES:   

SOUTINE:   

QTY. BUNCHES:   

VOGUE:   

QTY. BUNCHES:   

COMMENTS

DELIVERY DATE

SALMON PINK / CORAL ROSES SELECT TYPE, SIZE AND QTY - EACH BUNCHE CONTAINS 25 ROSES 

ENGAGEMENT:   

QTY. BUNCHES:   

MARLYSSE:   

QTY. BUNCHES:   

MOVIE STAR:   

QTY. BUNCHES:   

PECKOUBO:   

QTY. BUNCHES:   

WOW:   

QTY. BUNCHES:   

COMMENTS

DELIVERY DATE

HOT DARK PINK ROSES SELECT TYPE, SIZE AND QTY - EACH BUNCHE CONTAINS 25 ROSES

CATALINA:   

QTY. BUNCHES:   

ELIZA:   

QTY. BUNCHES:   

GILLIANCE:   

QTY. BUNCHES:   

HOT LADY:   

QTY. BUNCHES:   

HOT PRINCESS:   

QTY. BUNCHES:   

KAREN:   

QTY. BUNCHES:   

KIKO:   

QTY. BUNCHES:   

KING KONG:   

QTY. BUNCHES:   

POISON:   

QTY. BUNCHES:   

RAPHAELA:   

QTY. BUNCHES:   

RAVEL:   

QTY. BUNCHES:   

SHOCKING VERSILIA:   

QTY. BUNCHES:   

SOLITAIRE:   

QTY. BUNCHES:   

COMMENTS

DELIVERY DATE

Credit card   

Card Number    

Credit Card Secure Code    

Cardholder Name   

Cardholder Billing Address   

Expiration Date   

(MM/YY) 

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