Pick up date/time: _________________  or Delivery Date: ___________

Deliver to: _________________________________________________________

Address:  _________________________________________________________

City/State: _________________________________ Phone: ________________

Card Message: ____________________________________________________

__________________________________________________________________

__________________________________________________________________

Occasion: __________________________________   Basket or  Vase 

Colors and/or flowers to include or exclude: ______________________________
__________________________________________________________________

If requested flowers unavailable note second choice
     Second choice or similar to _____________________________________   
     Designers choice

Price range: $_______________  Minimum order $35
     Delivery Fee - Folsom = $8.00 | El Dorado Hills = 9.00 | Cameron Park = $10.00 |
     Granite Bay = $ 9.00 | Rancho Cordova = $ 9.00 | Gold River = $ 9.00
     World-wide delivery = $12 wire fee

Person ordering: _____________________________________________________

Address:  ___________________________________________________________

City/State: _________________________________ Phone: __________________

Credit Card (VISA, MC) _____________________________

Credit Card # ____________________________ Expiration Date: ______________