Holiday Flowers Ordering Form



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.

Autumn Splash
 Autumn Splash
Qty     Price each
Fall Grandeur
 Fall Grandeur
Qty     Price each
Autumn Celebration
 Autumn Celebration
Qty     Price each
Strikingly Chic
 Strikingly Chic
Qty     Price each
Orange Crush
 Orange Crush
Qty     Price each
Magic Moments Bouquet
 Magic Moments
Qty     Price each
Elegant Chic
 Elegant Chic
Qty     Price each
Orange Spice
 Orange Spice
Qty     Price each
Fields Of Europe
 Fields Of Europe
Qty     Price each
Autumn Boughs and Blooms
 Autumn Boughs and Blooms
Qty     Price each
Burst of Autumn
 Burst of Autumn
Qty     Price each
Pumpkin Patch
 Pumpkin Patch
Qty     Price each

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

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