Back - Flowers - Balloons - Gifts

 

Blossoms Group - Fax Order Form
 

To fax your order  please complete all  sections, then print and fax this page to 0113 239 0512.

 


SECTION A - ORDER DETAILS   
Please select the product reference, colour (where applicable) and price options.
 

Select Product
Please tick relevant box

Type/Description
Please select from options
available

 Flower Colour Options
 (Applies to BQ1, BQ2
& BQ3 only)

Cost Each
(Inc VAT/Delivery)

 
Flowers
Balloon
Chocolates
     


SECTION B - ADDITIONAL EXTRAS

The following items are available to add to all orders placed in Section A.    Should you wish to add any of the following items to your order please tick the appropriate product box. Please note that min order value of £20.00 is required in Section A to qualify for an additional purchase from the items below.
 

Add Balloon - £4.00

Add Belgian Chocolates

Add Bottle of Champagne (75cl) -  £35.00

 

Add Teddy Bear - £12.50  



SECTION C - DELIVERY INSTRUCTIONS
**Must be completed

Please note our terms and conditions for same day local, next day national and guaranteed next day delivery.  Please click here for details.
 

Delivery Date Required**

Delivery Time Preference*

 AM PM   
*Please note that this is not guaranteed. However, where possible, we will try our best to accommodate your request. 

Guaranteed Next Day
AM Delivery £5.00		 Tick the box if you require our guaranteed next day AM National  delivery - please note that an additional cost of £5.00 will be charged.  To qualify, orders must be received and paid for before 1.00pm Monday to Friday.  Please refer to our terms and conditions.


SECTION D – RECIPIENT/DELIVERY ADDRESS  
**Must be completed

Recipient Name:**

Address:**

Town/City:**

  Country: 

Postal Code:

  

Recipient Contact No **
(in the event of attempted or  non delivery of order)

Tel Code   Tel No. Other                       

Message to be sent with order
 (No more than 25 words please)


SECTION E - SENDER DETAILS
**Must be completed

Sender Name: **

 

Address: **

Town/City:**

   Country    

Postal Code: **

   

Contact No** Tel No (inc code)    Mobile   

Email Address:**

Anonymous Sender Please tick this box if you wish your gift to be sent without your name


SECTION F - PAYMENT/CREDIT CARD DETAILS
 ** Must be completed

Preferred Payment Method

Card Type**

Name on Card**

Card Holder Landline Number**
Must be confirmed for card authorisation. 		Landline Tel No (inc code)  
Registered Address of Card**
Must be confirmed for card authorisation. 		House No/Name      Postcode 
 

Card Number**

Issue Date**

 

Expiry Date**

 

Issue No #**

3 digit security pin**(Last 3 digits on reverse of card)

Please print and fax this page to 0113 239 0512.

 

 
Terms & Conditions * Privacy & Security * Delivery Terms

 

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 All rights reserved.  Revised: Samstag September 11, 2010.
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