VALENTINE’S DAY

ORDER FORM

If you wish to order flowers, either delivered to someone special or to have them ready when you walk into the store to pick up, we can take care of it for you.

Please fill out this form or call our store 03 94849760 to place your order, if is busy or after hrs please fill out this form and we will get back to you as soon as possible.

As we do not have online payments section set up yet, for your security we wont take card details on this form but will call to confirm price with you and put through card payment over the phone.

Customer Name *

Customer Name

First Name

Last Name

Email Address *

Phone Number *

Recipients Name *

Delivery Address *

Recipients Phone# *

Delivery Date

Message To Recipient *

Flower Requirements

Please let us know if there are any specific colours or seasonal blooms you would like.

Amount you wish to spend on flowers (additional cost for delivery)

776 High Street, Thornbury, VIC 3071

Ph - 03 94849760

flowers@northst.com.au

Monday - Saturday: 9:00am - 6:00pm

Sunday - 10:00am - 4:00pm