Fax orders to: 312.432.9813

Phone: 312.432.1800

Email: custserv@ashaddflorist.com


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 $10.95 per address

 
 

Out of town deliveries $11.95 per address

 
 

FTD service charge (out of town only) $4.00 per address

 
 

Sales tax (all orders) 9%

 
 

Grand Total

 

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:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

*