Fill out below form, then print and fax to 918-962-4481
| Name: | |
| Street Address: | |
| City: | |
| State: | |
| Zip Code: | |
| Phone Number: |
| Items Ordered: | Quantity Ordered | Amount |
| Fruit Basket |
Small
($ )
Medium ($ )
Gourmet Large ($ ) |
Cash
Total of all Items Checked |
| |
||
| Snack Basket |
Small
($ )
Medium
($ )
Large
($ ) |
Cash
Total of all Items Checked |
| |
||
| Roses: |
One
Dozen Arranged ($ )
One Dozen Loose ($ ) |
Cash
Total of all Items Checked |
| |
||
Fresh Floral Arrangement |
Small ($ )
Medium ($ )
Large ($ ) |
|
| |
||
| Wedding Arrangement | Silk Arrangements $ Fresh Floral Arrangements $ | |
| |
||
| Funeral Arrangement | Silk Arrangements $ Fresh Floral Arrangements $ | |
| |
||
| Balloons (Prices depend on type of balloons.) | Mylar - . Latex Novelty ) | |
| |
||
| Total | ||
| |
| Credit Card Type: | ||
| Name on Credit Card | ||
| Credit Card Number | ||
| Expiration Date: |
Note: We reserve the right
to make any corrections to above price entries. We will contact you prior
to charging your credit card.