Customer Name Phone
Email Address
Recipient Name Recipient Phone
Recipient Address
Message
Flower Selection Spring Mix Flower Roses Tropical Mix Price $17.50* $25.50* $27.50 $37.50 $47.50 $57.50 $67.50 $77.50 $87.50 $97.50 Leis Oahu Island Hawaii Island*
Delivery Date January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Mondays Tuesdays Wednesdays Thursdays Fridays Time: before 12:30 PM 3:30 PM 5:30 PM
Please, Indicate which option that our carrier shall select if the recipient is not home.
1. Leave the merchandise on the recipient property. 2. Return the mechandise to the shop. 3. Please call the recipient before any delivery attempt.
CARD INFO
Example: Michael Jackson 4817-0006-2846-5000 334 3 digits on the back of your Visa or Master Cards.
submit Card Info with Order Form Card Expire Date CV Code above your signature
E-Mail and Phone No
Delivery Service Charge: Minimum $7.50