Fax Form

Blooming Roses Your #1 Internet Florist

Phone 925-371-8222 / Fax 925-371-8422

Fax Order Form - Please Print

Order can be filled out and faxed, or sent as an attachment in Email, or you may call us and we will fill it out for you.

Delivery Date: S M T W T F S (Circle one) ____AM ____PM

Deliver To:________________________________________________________________
Address:________________________________________________________________
Florist:________________________________________ Code: ___________
Contact Person:_________________________________________
Phone No.________________________________
Address:_________________________________________________________________

Item#	Description / Arrangement Type	Quantity	Item Price	Amount







			Delivery Charge:
			Service Charge:
			Sub Total:
			Tax:
			Total:

Occasion: Aniversary - Arrangements - New Born(Baby Boy)(Baby Girl) - Baby Shower - Birthdays -Custom Services - Dish Gardens/plants - For Loved Ones - Gourmet Basket - Get Well/Hospital - Weddings - Holidays - Just Because - Rose Arrangements - Sympathy/Funeral - Thank You - Thinking of You - Stuffed Animals - Weddings

Card Message:
Credit Card Information	CC#
Charge To:	Credit Card Type (Check One)
Name: (as it appears on the card)	Visa Mastercard American Express Discover COD Other

Billing Address:

City: State: Zip Code:

Daytime Phone: Fax #: Signature:

Evening Phone:

Order Date: Order Written By:

Terms and conditions: No deductions or credits will be allowed on any product unless the reason for complaint is received by us within 24 hours from the time product is received.
Fresh floral arrangements are guaranteed 100% for 24 hours from the time it was received by the customer.
Thank you for your order and doing business with BLOOMING ROSES YOUR INTERNET FLORIST.
New Accounts: _______
For wedding please use both regular and wedding faxable forms. Thank you for your cooperation.