PETALS on Palm Ave. Order Form
Fill in your information below
Name
......
Address
..
City
.......
State
..
ZIP
..
Phone
....
Cell
.
Choose Payment Method
Cash
Check
House Account
Visa
Master Charge
American Express
Discover
Select One
Email address:
(Please call us with your credit card Information to ensure security )
What do you want to spend?
$35.00
$40.00
v
$45.00
$50.00
$55.00
$60.00
$65.00
$70.00
$75.00
$80.00
$85.00
$90.00
$95.00
$100.00
$125.00
$150.00
Our minimum order is $ 45.00, with $12.00 delivery plus tax
What kind of arrangement do you want? Explain briefly.
What is the occasion?
Sympathy
Birthday
Anniversary
Baby Boy
Baby Girl
Get Well
Congratulations
Holiday
Other (Explain)
Choose One
If Other? Explain
Your expression on the card.
Delivery Information
Deliver to:
...
Address
......
City
.............
State
..
ZIP
..
Phone
..........
Special Instructions
Date to Deliver
..
Time to Deliver
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All Day 9:00A - 5:00P
AM 9:00A - 12:00P
PM 12:00P - 5:00P
Select One