Please note: Multiple orders for delivery to different addresses must each be on a separate form.

Please provide your contact information:

First Name *
 Last Name *
Phone Number  *
Fax
E-mail *

* Required fields

Please provide the following information for the item(s) you would like to order:

Qty. Item Description or Code Number (Please list each item separately, IE: flower arrangements, fruit & gourmet baskets, mylar balloons, gift items, etc). Click here for price information. Price
(All orders are made to value).
$
$
$
$
$

If you have a color preference for your flowers please select it below. If you do not have a preference or would like our designers to select something appropriate for the occasion please 
select "Designer's Choice".

Color Preference (Select One):
If "other" please describe:

Arizona state sales tax and delivery charges (if applicable) will be added to your order. Click here for tax and delivery information.

Occasion (Select One):
If "other" please describe:

Please provide the following delivery information:

Check One:
Pick-Up
Local Delivery
Out of Town Delivery
Delivery Date
Delivery Time am. pm.

(Please indicate delivery time only if you need delivery by a specific time of day. We will notify you promptly if delivery or pick-up time can not be guaranteed).

Recipient's Name(s)
(Please number if there is more than one recipient at the same address.) 
Street Address
Suite Or Apt. Number
City
State
Zip Code
Recipient's Phone Number

Special directions or instructions:

Would you like an enclosure card? Yes No Blank Card

Please type your card message below:
(If there is more than one recipient please number card messages corresponding with names as numbered above).

Please provide your account information if you have an account with us or a credit card on file:

ACCOUNT BILLING
Account Name Or Company Name
Account Number (if known)
Bill To Credit Card On File
Credit Card

Please provide your credit card information if you are paying by credit card:

CREDIT CARD BILLING
Cardholder's First Name
Last Name
Credit Card
Card Number
Expiration Date
Billing Address 
Suite or Apt. Number
City
State
Zip Code
Cardholder's Phone
 

Additional comments:

Thank You! 

(Please click the "Submit" button only once).


Copyright © 2002 [Enchanted Florist]. All rights reserved.
Revised: November 08, 2012 09:21 AM .