Order Form

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Order Information

Please provide the following ordering information:

QTY	CODE	DESCRIPTION	PRICE	SIZE

Please ad the courier fee to your order cost,

Same day, delivery to the Lincoln, Rolleston, Springston , areas of Canterbury, free

Delivery to: Christchurch City, Prebbleton, Greenpark, Halswell, Hornby, Irwell, Killinchy, 

Leeston, Yaldhurst, Southbridge, Tai Tapu, Templeton, $10                                                                   

Delivery to: Akaroa, Motukarara, Little River, Duvauchelle, Kirwee, Burnham, West Melton, Darfield, 

Sheffield, Rakaia, Dunsandel, Methven, Hororata, rural Mid Canterbury, $15                                           

Delivery to all other areas of Canterbury, around New Zealand and overseas, through Interflora

                                                                                                                                                   Total   

Delivery Details

Please provide delivery information

First Name
Last Name
Street Address
Address (cont.)
City
Post/Zip Code
Rapid Number		(A Rapid Number is required for rural deliveries as couriers will not deliver without it)
State/Province
Country
Home Phone
Work Phone
E-mail

Enter the date of delivery:

-- dd/mm/yy

Message to be included with flowers or gift

Sender Details

 Please provide the following contact information for confirmation of your order, 
     (we will reply to your order to let you know it has been received).

 If you do not get a personal email reply to confirm your order, please contact the shop directly on 03 3252621

Name
Contact Phone
E-mail

Payment

You will be redirected to the DPS Secure payment site when submit is pressed, to enter your credit card details.

If you prefer, you can call 00 6433252621, or fax 0064 33256135, or txt 0064 2163214 or email broadfieldflowers@xtra.co.nz, with your credit card details.

Broadfield Flowers.
Copyright © 1999 [Broadfield Flowers]. All rights reserved.