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Fax Order Form This is the address to which your receipt will be sent and also the phone number where we will confirm you order. Your name __________________________ Date ordered____________ Company __________________________________________________ Address___________________________________________________ City________________________State_______ Zip_________________ Phone:________________Fax: ______________Email:______________ Credit Information Name as it appears on card:____________________________________ Credit Card Number: __________________________________________ Expiration Date (MM/YY)___________Delivery Date Desired ____________ Occasion _________________ Number of total baskets_______________ Card message to Read:________________________________________ Company___________________________________________________ Address____________________________________________________ City__________________________State_________Zip______________ Phone:_______________________ Basket choice from from web ____________________price___________ -------------------------------------------------------------------------------- To: Name:_____________________________ Company:__________________________ Address___________________________ City_____________________________State_____Zip_____________ Phone:________________________ Basket choice from WEB___________________Price_____________
Name:_____________________________ Company___________________________ Address___________________________ City_________________________State _________Zip____________ Basket choice from WEB____________________Price____________
Name:_________________________ Company_______________________ Address_______________________ City________________________State _________Zip_____________ Basket choice from WEB____________________Price____________ |