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Order Number

Pick up or Delivery?*

Pick up

Delivery

**Note - minimum order for delivery is $175.00. Thank you.**

Pick Up / Delivery Date*

Please note, orders received after 3 pm on weekdays will be delivered on the following day.

Recipient's Name*

Prefix First Last

Address*

Street Address City State ZIP Code

Recipient's Phone*

What would you like to order?*

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Tell us about your flower preferences.

Is this order a gift?

Yes

Card Message

Your Name*

First Last

Your Phone Number*

Billing information*

Street Address City State ZIP Code

Your Email*

Your Credit Card Information

Phone

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