Weekly Flowers Order Form

Weekly Flowers Order Form
Program

12 Weeks of Tulips - Winter Program $15010 Weeks of Spray Roses - Summer Program $19010 Weeks of Alstromeria - Fall Program $125
Recipient Name*

First NameLast Name
Delivery Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Recipients Phone*

Area CodePhone Number
Customer Information

First NameLast Name
Customer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Phone

Area CodePhone Number
E-mail*
Payment Options

Option 1 (Save 20%) Billed in full on your Enchanted Florist statement the first month of programOption 2 (Save 20%) Pay in full by credit card on first day of programOption 3 Billed in 3 monthly installments to your Enchanted Florist statementOption 4 Billed in 3 monthly installments to your credit card during program
We will contact you if we do not have your credit card on file.
Special Instructions & Requests*
Anti Spam:*
Confirmation*

I am fully aware that I have read and agreed to abide the Terms and Conditions and upon the submission of this form I am obliged to pay for the item(s) specified above.
Should be Empty: