Crystal Order Form

CRYSTAL ORDER FORM

There are 3 ways to order: #1 Fill out the form below & Submit #2 Print form below & Fax to: 1-414-744-4973 #3 Call us at: 1-414-744-4970 #4 Email us at: orders@countryflowershopmilwaukee.com	Hours of Operation Mon. - Fri.: 8 Am - 5 Pm Saturday: 8 Am - 3 Pm Sunday: CLOSED
Orders can be placed 24 Hours a day through options #1 & #2. Orders placed outside the hours of operation will be processed the following day.

Delivery Information			Purchaser's Information
First Name:			First Name:
Last Name:			Last Name:
Company:			Company:
Address:			Address:
City:			City:
Country:			Country:
Province:			Province:
State/Zip Code:			State/Zip Code:
Home #:			Home #:
Work #:			Work #:
Other #:			Other #:
Please Provide Complete Information			E-mail:

Order Details
Name(s) of Pieces DESIRED (Please be specific)	Total $ Amount of item(s):
	Free Shipping
SPECIAL DELIVERY INSTRUCTIONS	Please make any additional comments or ask additional Questions HERE:

PAYMENT INFORMATION
Please Select Method of Payment Mastercard VISA American Express Discover Card In Store Account	Name on Card:
	Card #:
	Exp. Date:
	Zip Code Billed To:

Note: After hitting the "SUBMIT" button, you will be taken to a confirmation page. If you are not, your order or inquiry has not been sent. Please e-mail webmaster@inetonline.com to notify us of the problem.
Thank You!!!

Country Flower Shop
3101 E Layton Ave
Cudahy, WI 53110
(414) 744-4970

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