Special Moments Florist |

Special Moments Florist

2007 VALENTINE’S SPECIAL ORDER FORM

Print this page and drop it off at the store to save time!!

Name: _______________________________________ Phone: _____________________

Address: ____________________________________________Date: _______________

_____ To Be Delivered _____ Pick-up: Date: _____________ Time: _____________

Address to Deliver to: ____________________________________________________

_____________________________________________________________________

Directions: _____________________________________________________________

_____________________________________________________________________

Date to Deliver: __________________________________ Approx Time: _______ AM / PM

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ORDER

_____ ½ Dozen Red Roses in Vase = $26 _____ 1 Doz Red Roses in Vase = $52

_____ Single Red Rose in Bud Vase = $11 _____ 1 /2 Doz Wrapped Red Roses = $20

_____ Dozen Wrapped Roses = $40 _____ 11" Helium Balloon = $1.25

_____ Valentine’s Mylar Balloon = $4 _____ Stuffed Animal $____________

_____ Balloon Bouquet (1 Mylar & 6-11") = $11.50 _____ Candy $___________

_____ Mixed Floral Arrangement: Price Range: $________ to $_________ (Minimum $25)

_____ What to write on card:

______________________________________________________________

_____ Card Already filled out (attach to this order)

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This page to be filled out by Store Rep

_____ Cash _____ Check # ________ _____

Credit Card # ________________________________ Exp: ______ / _____

$__________ Total amount of Flowers

$__________ Balloon Cost (if applicable)

$__________ Stuffed Animal or Candy Cost (if applicable)

$__________ Delivery Charge (if applicable)

$__________ Tax 6%

$__________ Total Order

- $__________ Deposit Made (Minimum Deposit = $10)

$__________ Amount Due (Must be paid in full before delivery or at pick-up)