Order Form

Basket & Floral - Printable Order Form

Referred by: _________________________ Referred by PHONE # ___________________

407.850.1009 Fax 407.855.0041 DELIVERY DATE :____/____/_____
NO GUARANTEE ON DELIVERY TIMES WITHOUT PRIOR APPROVAL

Hotel, Apartment, Subdivision or Business Name _____________________________________

PHONE #: __________________ DELIVERY ADDRESS: _______________________________

DELIVER TO (NAME):_________________________________________________________

IF HOTEL - NAME ROOM IS REGISTERED UNDER: C/O __________________________________________

ITEMS ORDERED : ________________________________________________________________________

______________________________________________________________________________

CARD MESSAGE: _______________________________________________________________

_____________________________________________________________________________

PAYMENT: MASTERCARD _______ VISA ______ AMEX ______ DINERS CLUB _______ DISCOVER _______

NAME ON CREDIT CARD: __________________________________________________________________

ACCOUNT NUMBER___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ____ / ___ ____ ___ ___ EXP DATE____ ____

Three digit # on back of Visa / M.C. card. ___ __ ___ or Four digits #__ __ __ __ on front of Am. Exp. Card
CREDIT CARD HOLDERS MAILING ADDRESS☺ (where their credit card statement gets mailed to.)

House # _____________________________________________________ ZIP CODE __________

Cell: _________________________ Home: _________________________

Order Amount : ___________ Minimum Order is 35.00 + Delivery + Tax + Tip

Delivery : 15.00 Also a $3.00 Bellman, Star service, driver or

Sub Total : ___________ delivery tip may be required.

TAX 6.5 % : ___________

TOTAL : ___________ Plus tip $3.00 = GRAND TOTAL : ___________