Brouwer's Family
Flowers Ltd.
Our On-Line Order Form
.
For convenience, this order
form can be downloaded, filled out and faxed to us at (519) 974-4147
and we'll fax you back a confirmation number or, if you prefer, you can
call in your order to (519) 974-4003 or if you are long distance, call
us at 1-888-290-0222
.
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Your Name:_______________________________________________________
Telephone No.: ___________________ E-Mail
Address: _________________
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What Would You Like To Order:_____________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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Price Range: _______________________________________________________
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Send To: __________________________________________________________
Address: __________________________________________________________
__________________________________________________________________
Telephone Number:________________
Work: ____________________
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Greeting Note: _____________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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Method Of Payment: Visa
- Master Card
Card No: ____________________________
Expiry Date: _________________
Signature: ________________________________________________________
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