Holiday Flowers Ordering Form

Due to technical issues, our order forms are currently inoperative.
Please call us directly at (719) 471-1133 and we will be happy to assist you.

Select item, enter quantity and a price category.
You will be contacted within 24 hours for verification and special instructions.

** We reserve the right to make substitution
with the products based on product availability.

Billing Information
* Name
Company Name
* Billing Address
Billing Address
* City
* State
* Zip
* Phone
* Email address
* Confirm Email
* Required Information
*Delivery Information if different from above*
Name
Company Name
Address
Address
City
State
Zip
Phone

Special Instructions Delivery Card Message Delivery Date:
Credit Card Information
* Credit Card Discover Card MasterCard VISA
	* Name on Card * Credit Card Number	Exp. Date	Month	Year

A charge of $10 will be added to your order for Metro delivery.

We will call you to confirm your order within 24 hours.

1219 W. Colorado Ave.
Colorado Springs, CO 80904
e-mail: info@The-Basket-Case.net
Ph 719-471-1133 FAX 719-475-1700

Funeral Spray Qty Price each	Tribute Spray Qty Price each	Funeral Wreath Qty Price each	Serenity Arrangement Qty Price each
	Casket Spray (flower choice) Qty Price each	Casket Spray (color choice) Qty Price each
Vase Arrangement Qty Price each	Loving Memory Qty Price each	Flower Arrangement Qty Price each	Autumn Vase Qty Price each