Order Sheet
order date
Orderer
name
phone #
address
e-mail
Order
arrangement
bouquet
/ bouquet in vase
other
Budget
$
VISA
M/C
Delivery charges and applicable taxes not included (12% HST). All charges are in Canadian Dollars.
Please enter the first 12 digits of your credit card. We will confirm the last 4 digits and expiry date
by telephone for your security.
XXXX XX/XX
Date / request
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
AM
PM
any time
Pick up
delivery
We will contact you if we anticipate any problems with delivery.
Delivery to:
name
phone #
address
buzz #
Note
Please write the message as you would like it to appear on the enclosure card if required.
Occasion