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· O R D E R - F O R M ·
PRODUCTS

Geraniums		 Quantity:
 $1.25/each

Hibiscuses		 Quantity:
 $2.30/each

Honeysuckles		 Quantity:
 $1.75/each

Irises		 Quantity:
 $1.50/each

Pansies		 Color:(only one color per order please)
blue
blue/white
red
red/yellow
purple/white
white/purple
Quantity:
 $1.00/each

Peonies		 Quantity:
 $2.00/each

Petunias		 Quantity:
 $3.50/arrangement

Ranunculuses
(yes that's spelled right!)		 Quantity:
 $2.50/arrangement

Roses		 Color:(only one color per order please)
red
white
yellow
light purple
light yellow
orange
off white
burnt red
Quantity:
 $2.00/each

Tulips		 Quantity:
 $1.75/each

Violets		 Quantity:
 $1.25/each
Would you like to enclude any of the following:
baby's breath    extra greenery    greeting card
If you are sending a greeting card, what would you like it to say?
SUBTOTAL
$

COMPLETE ORDER

Billing Info

Mailing Info
(Required Info)

Name:(as it appears on the card)


Type of card:


Billing Address:(if different from shipping)
Street:
City:
State:
Zip:

Card Number:


Expiration Date:(mm/yy)

PLEASE DO NOT ENTER A REAL CARD NUMBER!!
(Required Info)

Name:


Address:
Street:
City:
State:
Zip:

Home Phone:(xxx)xxx-xxxx


Work Phone:(xxx)xxx-xxxx

Your Total: $
If this is not correct, please review your order(or my source code ;o) )