|
|
|
|
PLEASE PROVIDE SENDER INFORMATION |
|
|
|
|
|
|
|
First Name:
|
|
Last Name: |
|
|
Address: |
|
Zip Code:
|
|
|
City: |
|
State: |
|
|
|
Other
Country: |
|
|
Home phone:
|
|
Work phone:
|
|
|
Cellular: |
|
Email: |
|
|
|
|
|
|
PLEASE PROVIDE RECIPIENT INFORMATION |
|
|
|
|
|
|
|
First Name:
|
|
Last Name: |
|
|
Home: |
|
Business:
|
|
|
Address: |
|
Zip Code:
|
|
|
City: |
|
State: |
|
|
|
Other
Country: |
|
|
Home phone:
|
|
Work phone:
|
|
|
Cellular:
|
|
Email:
|
|
|
|
|
|
|
ORDER CHRISTMAS ARRANGEMENTS: |
ARREGLOS
DE NAVIDAD |
|
| |
|
|
|
CHRISTMAS
BOUQUET |
|
CHRISTMAS
CHER BOUQUET |
|
|
CHRISTMAS
ELEGANCE |
|
RUBY
GLASS BOUQUET |
|
|
CHRISTMAS
PALACE |
|
CHRISTMAS
NATIVITY |
|
|
CHRISTMAS
CRYSTAL |
|
CHRISTMAS
FLYER |
|
|
OUR
CHRISTMAS HOME |
|
FAMILY
CHRIS.
GOURMET |
|
|
MERRY
CHRIS. GOURMET |
|
CHRIS.
GOURMET PARTY
|
|
|
BIG
FAMILY GOURMET
|
|
CHRIST.
LOVE GOURMET
|
|
|
CANDLE
CHRISTMAS
|
|
MERRY
CHRISTMAS
|
|
|
LOTS
OF WISHES
|
|
CHRISTMAS
ROSES
|
|
|
THE
WATERFFORD HOLIDAY
|
|
GOLDEN
REINDEER
|
|
|
KINKADE
CHAPEL
|
|
CHRISTMAS
NIGHT
|
|
|
SEASONS
GREETINGS
|
|
HAPPY
HOLIDAY
|
|
|
SANTA'S
GIFT
|
|
WONDERFUL CHRISTMAS
|
|
|
SANTA'S
LOVE
|
|
BEAUTIFUL
HOLIDAY
|
|
|
CHRISTMAS TREE
|
|
ENCHANTED
|
|
|
COLORS
OF
CHRISTMAS
|
|
CHRISTMAS
FRUIT
|
|
|
FRUIT
TROPICAL
CHRISTMAS
|
|
FAMILY
CHRISTMAS FRUIT
|
|
|
|
|
|
|
BALLOONS |
|
CHOCOLATES |
|
|
ORCHIDS |
|
SPECIAL
CARD |
|
| |
|
|
|
|
ENTER YOUR CARD MESSAGGE |
|
|
|
|
| |
|
|
|
| |
DATE
OF DELIVERY |
|
|
|
COMMENTS OR SPECIAL INSTRUCTIONS |
|
|
|
|
| |
|
|
|
|
PAYMENT INFORMATION |
|
|
|
PLACE YOUR
ORDER - WE WILL
CONTACT YOU BY PHONE TO COLLECT YOUR PAYMENT INFO |
|
PONGA SU ORDEN
- LO LLAMAREMOS PARA PEDIR LOS DATOS DE SU TARJETA |
| |
|
|
| |
Credit Card |
|
|
| |
Card
Number |
|
|
| |
Credit card
Secure Code |
(3 Numbers - see back of your Card) |
| |
Cardholder Name |
|
|
| |
Cardholder
Billing address |
Complete of Zip code |
| |
Expiration Date |
|
(Format MM/YY) |
|
| |
|
|
|
|
We will contact you via
e-mail or phone shortly with your order confirmation. |
|
Please verify your
information carefully before submitting for ordering. |
| |
|
|
|
|
|
|
|
