Flowers for Him - Ordering

We will proudly deliver your personalized floral gift to all
Phoenix Arizona Metropolitan Cities.

Recipient Information
Recipient's First Name:
Recipient's Last Name:
Recipient's Phone:
Delivery Date:
Recipient's Work Hours:
Delivery Address:
Suite# / Apt #:
Name of Business:
Delivery City:
Delivery State:		Arizona
Delivery Zip Code:
Occasion:
Explanation of "Other" Occasion:
Message on Enclosure Card:
Signed:

Your Information
First Name:
Last Name:
Phone:
Mobile Phone:
E-mail Address:
I like this floral arrangement - (Enter Floral Arrangement Name):
I would like to stay within the following Price Range:
Anything More You Would Like To Tell Us?:
Have you provided us with your DAYTIME PHONE NUMBER so we can confirm your order by taking your credit card information? We will contact you by tomorrow 10:30am MST. OR We are happy to accept your VISA, MC, American Express, Discover, Novus, or Diners Club numbers information for payment below:
Not a secure site	Type of Card:
	Credit Card Number:
	Card Expiration Date:
Do you want a phone confirmation? Yes No

Delivery included in price:	Fuel Charge Enacted 11-12-07:
Scottsdale Phoenix Tempe ParadiseValley Mesa Chandler Gilbert Guadalupe	Ahwatukee Foothills Apache Junction Avondale Buckeye Cave Creek Care Free Desert Hills El Mirage Estrella Mtn Ranch Fountain Hills	Fort McDowell Gila Bend Goodyear Litchfield Park Peoria Sun City Sun Lakes Surprise Tolleson Verrado

Frequent Deliveries Are Made To The Following Health Care Facilities:
Abrazo Health Care Arizona Heart Institute Arizona Orthopedic Surgical Hospital Arizona State Hospital Banner Health Barix Clinics Healthsouth Surgery Centers John C. Lincoln Health Network Kindred Hospital Los Ninos Hospital	Mayo Clinic and Hospital Mesa General Hospital North Valley Surgery Center Paradise Valley Hospital Phoenix Children's Hospital St. Lukes Medical Center Scottsdale Healthcare Tempe St. Lukes Hospital Veterans Affairs Medical Center & Select Specialty Hospitals

Frequent Deliveries Are Made To The Following Funeral Facilities:
A L Moore A Caring Touch A South Mountain Abel Advantage Angels Arcadia Arrowhead Best Bueler Carr-Tenney Catholic Cemeteries Chapel of the Chimes Eastlake	Falconer Green Acres Greenwood Memory Hansen Harper La Pax Lowmans Life-Paths Meldum Mercer Messinger Mortensen Kings Mountain View Neptune	Paradise Phoenix Memorial Preston Queen of Heaven Ragsdale Emily Resthaven Rude Family Sahl Glenn D Samaritan Sinai Tempe Universal Webber's Whitney & Murphy

Phone: 1-480-994-8464 Toll Free:1-800-450-5062 E-mail: customerservice@flowersforhim.com