DATE ORDERED: ________ COMPLETED: _______ SENT: ______ BILLED: ________
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FROM:
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________________________________________________________ ________________________________________________________ ________________________________________________________
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TO:
___________________________________________
__________________________________________________ __________________________________________________ __________________________________________________
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METHOD
OF PAYMENT: MC ___ VISA ___ AMEX ___ DIS ___ CHECK ___ CASH ___ |
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| CREDIT CARD # _____________________________ | EXPIRATION DATE: __________________ | ||||||||||||||||
| OCCASION FOR GIFT:_____________________________________________________________ | |||||||||||||||||
| AMOUNT TO SEND: _____________ | EXCLUDING TAX & SHIPPING ___________ | ||||||||||||||||
| INCLUDING TAX & SHIPPING ___________ | |||||||||||||||||
| CONTAINER TYPE: BOWL ___ FLOWER POT ___ BAG ___ OTHER _______________________ | |||||||||||||||||
| DIETARY CONSIDERATIONS : ______________________________________________________ | |||||||||||||||||
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| _________________________________________________________________________________ | |||||||||||||||||
| MESSAGE: _______________________________________________________________________ | |||||||||||||||||
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