Fresh Flowers Ordering Form

Due to technical issues, our order forms are currently inoperative.
Please call us directly at (719) 471-1133 and we will be happy to assist you.

Select item, enter quantity and a price category.
You will be contacted within 24 hours for verification and special instructions.

** We reserve the right to make substitution
with the products based on product availability.

Billing Information
* Name
Company Name
* Billing Address
Billing Address
* City
* State
* Zip
* Phone
* Email address
* Confirm Email
* Required Information
*Delivery Information if different from above*
Name
Company Name
Address
Address
City
State
Zip
Phone

Special Instructions Delivery Card Message Delivery Date:
Credit Card Information
* Credit Card Discover Card MasterCard VISA
	* Name on Card * Credit Card Number	Exp. Date	Month	Year

A charge of $10 will be added to your order for Metro delivery.

We will call you to confirm your order within 24 hours.

1219 W. Colorado Ave.
Colorado Springs, CO 80904
e-mail: info@The-Basket-Case.net
Ph 719-471-1133 FAX 719-475-1700

	One Dozen Long-Stem Roses				Dish Gardens
	Qty Price each				Qty Price each
	Two Dozen Long-Stem Roses				Floral Delight
	Qty Price each				Qty Price each
	Foliage Plants				Mixed Bouquet in Vase
	Qty Price each				Qty Price each
	Tropical Paradise				Best of Both Worlds
	Qty Price each				Qty Price each
	Simply Lovely				Make Her Day
	Qty Price each				Qty Price each
	Beary Adorable				To You!
	Qty Price each				Qty Price each