Order
Qty.
   
       
 
Order No. 1
  
  Order No. 2  
  Order No. 3  
  Order No. 4  
     
 
From
   
       
 
Name
Company
  
 
Address
City
  
 
Province/State
Postal /
Zip Code
  
 
Country
   
 
Daytime Phone
E-mail
  
           
 
Deliver to
 
     
 
Delivery Date
Delivery
Time
  
 
Name
Company
  
 
Address
City
  
 
Province/State
Postal /
Zip Code
  
 
Country
   
 
Daytime Phone
E-mail
  
 
Card Type
              
 
Message
              
                               
 
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    For security purpose please call us
with your card number.
1-800-565-4834.
Or simply just submit the form with your
information's and one of our staff will
contact you.
Or print this form and fax it to (519) 432-3915
Internationl Fax No. 011-09-519-432-3915		  
   
     
   
   
   
                               
Flowers To USA
1080 Adelaide St. North
London, Ontario Canada
1-800 565-4834
Tel: 011-09-519-432-1713
Fax: 011-09-519-432-3915E-mail: regency@execulink.com
    All currencies listed are US dollars. If delivery is
unavailable in a certain region we will contact you
as soon as possible.