Garland Flowers
Flowers by Post from Jersey
The Perfect Gift for All Occasions

Mail or Fax Order Form

Please print and complete this order form in block capitals and send it with your payment to Garland Flowers, 102-108 Central Market, St Helier Jersey JE2 4WL, Channel Islands, British Isles or fax it to 01534-862439 (UK) or +44-1534-862439 (international)

BOUQUET NAME: ________________________________________
PRODUCT CODE: __________
BOUQUET PRICE: UK £ __________
(Tick if required) Registered Delivery (for orders despatched Mon-Thu) £8.50
SPECIAL REQUIREMENTS: __________________________________________________
(if applicable) __________________________________________________
 
FROM (NAME): ________________________________________
E-MAIL ADDRESS: __________________________________________________
ADDRESS: __________________________________________________
  __________________________________________________
POST CODE: ____________________
TELEPHONE NO: ______________________________
PAYMENT BY: Postal Order / Cheque / Credit Card (underline one)
 
CREDIT CARD TYPE: Access / Visa / Mastercard / Delta / Eurocard (underline one)
CARD NO: ________ / ________ / ________ / ________
CARD START DATE: _______________
CARD EXPIRY DATE: _______________
CARD ISSUE No.: _______________
3 DIGIT SECURITY CODE: _______________
NAME ON CARD: ________________________________________
SIGNATURE: __________________________________________________
DATE OF ORDER: _______________
 
TO NAME: ________________________________________
TO ADDRESS: __________________________________________________
  __________________________________________________
TO POST CODE: ____________________
TO ARRIVE BY: __________
 
PERSONAL MESSAGE: __________________________________________________
  __________________________________________________
(Max 10 words)
Last updated: 15th of September 2005 by JerseyWeb