Product #: SFN-010-3

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Please select the desired product price:

As Shown:                     $69.95        (designed as shown)
Upgrade Deluxe:           $74.95        (an addition of more filler and flowers in order to give arrangement a fuller appearance)
Upgrade Premium:        $79.95        (addition of more flowers and filler to give arrangement a larger, more full, demanding presence - Premium appearance)



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Please select any additional product upgrades:

Teddy Bears:

          $9.95    (small bear)         
          $14.95  (medium bear)
          $24.95  (large bear)
          No Thanks, I will not be needing to add a bear to my order today!

Mylar Balloons:

          $4.95     (1 mylar)
          $14.95   (3 mylars)
          $29.95   (6 mylars)
          $49.95   (1 dozen mylars)  
          No Thanks, I will not be needing to add any balloons to my order today! 

Theme of Mylars: If you have decided to add mylar balloon(s), Please select one of the following themes below:
         
          Anniversary
          Baby Boy
          Baby Girl
          Birthday
          Get Well
          Love
          You're The Greatest

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                                                                                              Step 1 -  Delivery Information:


                             Please Enter Delivery Date By Selecting Values in the Drop Down Menus - *Click on black down arrow for selections

                                                                                                  select month January February March April May June July August September October November December     select day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

_________________________________________________________________________________________________________________________________________                                                                                            Step                                                                                            Step 2 - Recipient Information:

 Recipient Name:

           *Please include apt number, hospital room number, or office suite number
     Recipient Address:     
                                        
                                        
                               *We are unable to deliver to p.o. boxes or rural route addresses                      
City:          State:           Zip:

Country:

Phone Number:   Area Code No.

Name of Apartment Building / Office Building / Hospital - *If applicable


Please enter any special instructions for delivery:





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Step 3 - Card Message Information:

Please Enter Card Message:
*Limited to 175 characters with signature



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Step 4 - Sender Information:

Sender Name:

*Please include apt number, hospital room number, or office suite number
     Sender Address:         
                                        
                                        
                                
City:          State:           Zip:

Country:

Phone Number:   Area Code No.

Email Address:

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Step 5 - Billing Information:

Please Select Credit Card Type:    Visa             Mastercard           American Express           Discover

Please Enter Credit Card Number:

Please Enter Expiration Date By Selecting Values in the Drop Down Menus - *Click on black down arrow for selections

Month: select month January February March April May June July August September October November December       Year: select year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015


Card Holder Name - *As it appears on card  

Credit Card Statement - Billing Address
                                                              
                                                             
City:        State:       Zip:

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Step 6 - Customer Survey:

How did you find us? - Please select from one of the following options below:

Yahoo Looksmart Google ODP Alta Vista Hot Bot AOL
MSN Gigablast Excite Other Search Engine (Please enter name)

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Step 7 - Checkout:

( $8.50 for delivery and any applicable tax will be added to your order )

YOUR ORDER IS ALWAYS SAFE WITH Send Flowers Nationwide

All information entered will be encrypted and sent over Internet Industry Standard SSL - Secure Socket Layer
to ensure your safety and privacy

I am ready to submit my order to Send Flowers Nationwide:



Thank You For Your Order !


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