Phone: 312.432.1800 Email: custserv@ashaddflorist.com
Fax orders to: 312.432.9813
FAX
ORDER FORM
FROM:
Business: ______ Personal:_________
Name:________________________________________________________________________________
Business Name:_______________________________________________________________________
Phone #:________________________________________________________ Extension_________________________
Email:_____________________________________________________________________________
Fax #:_________________________________________________________________________________
Payment Options:
Ashland Addison Account Number:___________________________________________________________________
Credit Card #:_______________________________________________________________________________________
Credit Card Type:____________________________________________________________________________________
Expiration Date:______________________________________________________________________________________
Name as it appears on Credit Card:___________________________________________________________________
Product Information
|
Item # |
Quantity |
Product Description |
Price per item |
Total |
|
Local Delivery $11.95 per address |
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|
Out of town deliveries $13.00 per address |
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|
Special Request Timed Deliveries $5.00 per address |
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|
Sales tax (all orders) 9.75% |
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|
Grand Total |
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Occasion: (circle one)
1 - Sympathy, 2 - Get Well, 3 - Birthday, 4 - Business,5 - Holiday, 6 - Baby, 7 - Anniversary, 8 - Other
Additional occasion info______________________________________________________________________________
Delivery Information:
Special timed deliveries may require a $15.95 delivery fee.
Single Address
Y__ N___
Delivery Date:__________
(If not all the same, please note by recipient name)
Name:_______________________________________________________________________________________________
Business Name___________________________Dept/Suite__________________________________________________
Address______________________________________________________________________________________________
City________________________________________State____________________Zip______________________________
Item Name or #:______________________________________________________________________________________
Card Message:
______________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________
Multiple Recipients
• Name:__________________________________________________________________________
Business Name___________________________Dept/Suite_________________________________
Address_____________________________________________________________________________
City____________________________________State__________Zip___________________________
Item Name or #:_____________________________________________________________________
Card Message:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
• Name:__________________________________________________________________________
Business Name___________________________Dept/Suite_________________________________
Address_____________________________________________________________________________
City____________________________________State__________Zip___________________________
Item Name or #:_____________________________________________________________________
Card Message:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
• Name:__________________________________________________________________________
Business Name___________________________Dept/Suite_________________________________
Address_____________________________________________________________________________
City____________________________________State__________Zip___________________________
Item Name or #:_____________________________________________________________________
Card Message:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
• Name:__________________________________________________________________________
Business Name___________________________Dept/Suite_________________________________
Address_____________________________________________________________________________
City____________________________________State__________Zip___________________________
Item Name or #:_____________________________________________________________________
Card Message:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Additional Notes or Comments:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
