 Please print out and fill in this form and Fax to 01326 280301 |
| Your
Details: Name: Address: Contact Number: |
Delivery
Details: Name: Address: Contact Number: |
|
Please
Choose your Box Size (No of stems)
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|
Box A 30 Stems £12.00 |
Box B 40 Stems £14.00 |
Box C 50 Stems £16.00 |
Box D 60 Stems £18.00 |
|
Flower
Choice
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1 |
2 |
3 |
4 |
Selection of all |
| Message
for gift card: |
Delivery Date:
(mm/dd/yy)  __
__ / __ __ / __ __ |