Order Form

     Please provide the following ordering information:

QTY	CODE, DESCRIPTION , PRICE AND SIZE

If you have any concerns about credit card security please call 00 64 33252621, or fax 0064 33256135, or txt to 0064 2163214 with your credit card details.

	BILLING
Credit Card	VISA MasterCard American Express Diner's Club Discover
Cardholder Name
Card Number
Expiration Date

     Please provide delivery information, for rural deliveries please include a rapid number:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
or Work Phone
or E-mail

          Enter the date of delivery:

-- dd/mm/yy

Message to be included with flowers or gift

   Please provide the following contact information for confirmation of the order or if there is difficulty with delivery:

First Name
Last Name
Home Phone
E-mail