Order Description 
 
What type of arrangement would you like to send?  Example: seasonal variety, potted plants, orchids, etc . You can leave this blank if you like, and we'll design something wonderful for you.  
 
 
How should the enclosed card read?  
 
 
What is the occasion?  Any additional comments for the designers? Example: Just Because, Birthday, Condolences   
 
 
Delivery Date 
Jan 
Feb 
Mar 
Apr 
May 
Jun 
Jul 
Aug 
Sep 
Oct 
Nov 
Dec 
 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
 
2020 
2021 
2022 
2023 
2024 
2025 
2026 
2027 
2028 
2029 
2030 
 
 
Before tax and delivery fees, how much would you like to spend? 
$ 
 
Delivery Charge 
$12.50  
 
Tax Rate 
9.250 % 
 
Total 
  
 
 Recipient Information 
 
Who are you sending flowers to? 
  
 
First Name 
 
 
Last Name 
 
 
Street Address 
 
 
  
 
 
  
 
 
City 
 
 
State / Province (2 letter code for US) 
 
 
Zip / Postal Code 
 
 
Country 
  United States 
   Albania 
   Algeria 
   American Samoa 
   Andorra 
   Angola 
   Anguilla 
   Antarctica 
   Antigua And Barbuda 
   Argentina 
   Armenia 
   Aruba 
   Australia 
   Austria 
   Azerbaijan 
   Bahamas 
   Bahrain 
   Bangladesh 
   Barbados 
   Belarus 
   Belgium 
   Belize 
   Benin 
   Bermuda 
   Bhutan 
   Bolivia 
   Bosnia and Herzegowina 
   Botswana 
   Bouvet Island 
   Brazil 
   British Indian Ocean Territor 
   Brunei Darussalam 
   Bulgaria 
   Burkina Faso 
   Burma 
   Burundi 
   Cambodia 
   Cameroon 
   Canada 
   Cape Verde 
   Cayman Islands 
   Central African Republic 
   Chad 
   Chile 
   China 
   Christmas Island 
   Cocos (Keeling) Islands 
   Colombia 
   Comoros 
   Congo 
   Congo, the Democratic Republi 
   Cook Islands 
   Costa Rica 
   Cote d'Ivoire 
   Croatia 
   Cyprus 
   Czech Republic 
   Denmark 
   Djibouti 
   Dominica 
   Dominican Republic 
  East Timor 
   Egypt 
   El Salvador 
   England 
   Equatorial Guinea 
   Eritrea 
   Espana 
   Estonia 
   Ethiopia 
   Falkland Islands 
   Faroe Islands 
   Fiji 
   Finland 
   France 
   French Guiana 
   French Polynesia 
   French Southern Territories 
   Gabon 
   Gambia 
   Georgia 
   Germany 
   Ghana 
   Gibraltar 
   Great Britain 
   Greece 
   Greenland 
   Grenada 
   Guadeloupe 
   Guam 
   Guatemala 
   Guinea 
   Guinea-Bissau 
   Guyana 
   Haiti 
   Heard and Mc Donald Islands 
   Honduras 
   Hong Kong 
   Hungary 
   Iceland 
   India 
   Indonesia 
   Ireland 
   Israel 
   Italy 
   Jamaica 
   Japan 
   Jordan 
   Kazakhstan 
   Kenya 
   Kiribati 
   Korea (South) 
   Korea, Republic of 
   Kuwait 
   Kyrgyzstan 
   Lao People's Democratic Repub 
   Latvia 
   Lebanon 
   Lesotho 
   Liberia 
   Liechtenstein 
   Lithuania 
   Luxembourg 
   Macau 
   Macedonia 
   Madagascar 
   Malawi 
   Malaysia 
   Maldives 
   Mali 
   Malta 
   Marshall Islands 
   Martinique 
   Mauritania 
   Mauritius 
   Mayotte 
   Mexico 
   Micronesia, Federated States 
   Moldova, Republic of 
   Monaco 
   Mongolia 
   Montserrat 
   Morocco 
   Mozambique 
   Myanmar 
   Namibia 
   Nauru 
   Nepal 
   Netherlands 
   Netherlands Antilles 
   New Caledonia 
   New Zealand 
   Nicaragua 
   Niger 
   Nigeria 
   Niue 
   Norfolk Island 
   Northern Ireland 
   Northern Mariana Islands 
   Norway 
   Oman 
   Pakistan 
   Palau 
   Panama 
   Papua New Guinea 
   Paraguay 
   Peru 
   Philippines 
   Pitcairn 
   Poland 
   Portugal 
   Puerto Rico 
   Qatar 
   Reunion 
   Romania 
   Russia 
   Russian Federation 
   Rwanda 
   Saint Kitts and Nevis 
   Saint Lucia 
   Saint Vincent and the Grenadi 
   Samoa (Independent) 
   San Marino 
   Sao Tome and Principe 
   Saudi Arabia 
   Scotland 
   Senegal 
   Seychelles 
   Sierra Leone 
   Singapore 
   Slovakia 
   Slovenia 
   Solomon Islands 
   Somalia 
   South Africa 
   South Georgia and the South S 
   South Korea 
   Spain 
   Sri Lanka 
   St. Helena 
   St. Pierre and Miquelon 
   Suriname 
   Svalbard and Jan Mayen Island 
   Swaziland 
   Sweden 
   Switzerland 
   Taiwan 
   Tajikistan 
   Tanzania 
   Thailand 
   Togo 
   Tokelau 
   Tonga 
   Trinidad 
   Trinidad and Tobago 
   Tunisia 
   Turkey 
   Turkmenistan 
   Turks and Caicos Islands 
   Tuvalu 
   Uganda 
   Ukraine 
   United Arab Emirates 
   United Kingdom 
   United States 
   United States Minor Outlying 
   Uruguay 
   Uzbekistan 
   Vanuatu 
   Vatican City State (Holy See) 
   Venezuela 
   Viet Nam 
   Virgin Islands (British) 
   Virgin Islands (U.S.) 
   Wales 
   Wallis and Futuna Islands 
   Western Sahara 
   Yemen 
   Zambia 
   Zimbabwe 
 
 
 
Recipient Phone 
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Alternate Phone 1 
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Alternate Phone 2 
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