Your Information
Your Name
Your email address
Your phone number
Your billing address
Please provide
complete address
including zip code.
Payment Information
Credit card type
Credit Card Number
xpira
Recipient Information
Desired date of
delivery
Recipient's Name
Recipient's Phone
Number
Delivery Address
(If business, please
include company name
and suite number.)
Name of Business
if business delivery
Delivery Type
Delivery Area
Due to the size of cards, please limit your message to no more
than 250 characters or about 20 - 30 words.
Message
Signature
(e.g. "Love, Bob")
Type of
arrangement
Upgrade
Arrangement
Your total budget
including delivery
How did you hear
about us?
Additional Instructions
or Information
New orders require credit card owner verification or signed
payment authorization form.
Please input credit card information or leave blank, complete
order and call us to arrange payment
Expiration
Your Information
Format 555-555-5555
CVS Number
CVS number is a 4 digit number on the front of your AMEX card and a 3 digit number on the
signature panel on the back of your VISA, MC and Discover card.
Format 555-555-5555
Thank you for choosing Express Flowers.
THIS IS NOT AN AUTOMATED ORDERING
PAGE.  PLEASE CALL US TO CONFIRM YOUR
ORDER AND DISCUSS IN DETAIL YOUR
FLORAL ARRANGEMENT AND PRICING.  WE
CANNOT PROCESS YOUR ORDER UNTIL WE
SPEAK TO YOU.