Please use the form below to place your order for pick up or delivery.

  1. Please provide the following contact information:

    First Name
    Last Name
    Contact Number for Payment
    (this needs to be a number we can call you at as soon as we get this order)
    Home Phone
    FAX
    E-mail

  2. Please provide the following product information:

    Product Name
    Product Code
    Price Range

  3. Please provide the following ordering information if ordering more than one item:

    QTY Product Code and Price range

    If this order is for pick up at our store please let us know in the special instructions box below

    SHIPPING
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country

  4. Special Instructions


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Copyright © 2002 Flowers By Marcelle. All rights reserved.
Revised: November 06, 2002