FLORAL 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.

Orders received by noon (CST) will be delivered the same day in the continental United States. Overseas orders are an extra $15, deliveries anywhere in the World take three to four days. EXPRESS orders to be delivered within Milwaukee and Waukesha's area will be delivered within two hours, $15.00.

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
ITEM # OR DESCRIPTION OF PRODUCT DESIRED (Please be specific)	DELIVERY DATE
	Order can be same day if ordered by 11:00am EST / Noon CST (Except Sundays and Holidays)
SPECIAL DELIVERY INSTRUCTIONS	OCCASION
	Total $ Amount of item(s):
CARD MESSAGE - 150 characters Max	Delivery Charge:
	Please include 5.60 % tax:
	Total Amount of Order:
The 'Delivery Charge' box contains the cities covered by our delivery vehicles and delivery charges. If your order is outside our coverage, please include $12.00 for delivery. If you order is to be delivered outside of the U.S., there is a $15.00 DELIVERY/RELAY charge...
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!!!