Boulder Creek Flowers and Design Center
Fax Order Form
(Use for pick-up, local delivery and wire-out orders)
                             
Order Date                         Order Time                          
*Same day local delivery orders must be received by 1 PM Pacific Time
   
Order Type   (þselect one) o Pick-up o Local Delivery o Wire-out  
Date and time for pick-up, local delivery or wire-out                                  
                                                                       
Account Information: *Account #:              
As it appears on your credit card statement Name                                   Will be provided after initial order so credit card info will not need to be provided again on subsequent orders
Address                                                          
City                       State               Zip Code            
Contact Phone   (     )               *Fax #   (     )              
*E-mail Address                                                    
Card Type   (þselect one) o Visa o Mastercard o American Express o Discover
Card Number                           Exp. Date             CCV #        
Authorization Signature:                                         (last 3 digits on back of card)
                                                                       
Order Description: Describe below the type of arrangement you would like and any flowers you would like
included or excluded from the arrangement (ie:  Spring mix vase arrangement with lilies / Sympathy basket for a man, etc.)
   
   
   
                                                                       
Amount of Order: How much do you want to spend on the arrangement, excluding sales tax, delivery fee or 
wire-service fee.  Sales tax is 8 %, delivered orders are typically $10.00, and wire-out orders have a $10.00 service fee.
  $
  Note:  Local delivery orders to funeral homes      
  and hospitals have no delivery charge. $35.00 minimum on delivered and wire-out orders
                                          o *Copy of invoice requested        
Delivery Information: o *Delivery confirmation requested                    
For delivered and wire-out orders only Name                                                            
Address                                                          
City                       State               Zip Code            
Contact Phone   (     )                                            
                                                                       
Card Message: (Limited to 25 words)
   
   
   
   
                                                                       
Fax completed form to our secure fax line at (831) 462-0913
*E-mail address required so we may send you your account number information and delivery confirmation.
          Fax number required if you would like a copy of your invoice faxed to you.