| www.baskets.com.au ORDER FORM' | |
| Devine Gift Baskets and Flowers. | Please fax this form to 61 2 9588 3935 |
| Company Name | |
| Surname: ____________________________ | Given Name: __________________________ |
| Phone - wk: __________________________ | Email: ________________________________ |
| Mobile ______________________________ | |
| Credit card holder name: ______________________________________________________ | |
| Credit card no: _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ | Exp. date: _ _ _ _ _ Security Code: _ _ _ |
| Signature: |
| Basket, Hamper or Flowers, Name or code: | Qty | Price |
| ____________________________________________________ | _______ | _______ |
| ____________________________________________________ | _______ | _______ |
| ____________________________________________________ | _______ | _______ |
| *Please refer to our on line Order form for pricing Delivery: | |
| * Interstate, Country (Devine's will confirm delivery cost for country area ) | |
| * Delivery not available on Sundays | |
|
Total: |
| Gift Tag Message: |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| Recipient Details: Company Name:_____________________________________________ |
| Name: ____________________________________________________________________ |
| Address: __________________________________________________________________ |
| _________________________________________________________________________ |
| State: _____________ | Postcode: ___________ Phone No: |
| Delivery date: ______________________________________ |
Thank you for using the services of Devine
Gift Baskets and Flowers.
www.baskets.com.au