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.

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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Fields Of Europe Qty Price each	Autumn Boughs and Blooms Qty Price each	Burst of Autumn Qty Price each	Pumpkin Patch Qty Price each