SILVER FOX FLORIST Fax Order Form

1 (586) 979-9096 FAX
PRINT this form, FILL it in, and FAX it to us
FROM: 


Name_______________________________________________________________________________



E-mail Address_____________________________________________________________________



Phone Number__________________________ Best Time To Call___________________________





DELIVER TO: 


Name_______________________________________________________________________________



Address____________________________________________________________________________



City/State/Zip_____________________________________________________________________



Delivery Date______________________________________________________________________



Phone Number_______________________________________________________________________



Flower Arrangement_________________________________________________________________



Price on Web Page*_________________________________________________________________

*A $4.99-$14.99 Delivery Charge will be added to each order, depending on destination.

 Sunday delivery NOT available, in most areas.



CREDIT CARD INFORMATION:    MC___  VISA___   AMEX___   DISCOVER___



Name on Credit Card________________________________________________________________



Credit Card Number_________________________________________________________________



Expiration Date______________________ Signature____________________________________



For fraud prevention, AND YOUR PROTECTION, the bank requires the address

where your credit card statements are sent. If the Name, Address and 

Credit Card information do not match, the bank will NOT approve it. 

This second level of security is important to safeguard your number.



Address____________________________________________________________________________



City/State/Zip_____________________________________________________________________



CARD INSCRIPTION:__________________________________________________________________



___________________________________________________________________________________



SPECIAL DELIVERY INSTRUCTIONS:___________________________________________



___________________________________________________________________________________

We will email you to acknowledge receipt of your order, 
so you can be sure it transmitted