Mrs. Flowers' Order form

Mrs. Flowers' Order Form
Mrs. Flowers Tel. 662-930-3196 Fax 662-930-3659(auto 24hr.)
or e-mail us at MrsFlowersInfo@yahoo.com

Item: P14

Six pack of chocolate crunch made with premium quality chocolate--the same one that has been our signature for thirty years is delivered with a single red rose.
Price: 45US$

Customer e-mail :		(required)
Customer's Name :
Address1 :
Address2 :
City and Country :
Contact Work phone no :		(required)
Contact Night Phone No :		(required)
Deliver to:
Address1 :
Address2 :
City :
Zip Code :
Country :		Thailand
Home Phone : (Bangkok's addresses are not systematic; we need the Tels to verify the location)		(required)
Work Telephone :		(required) Extension :
Delivery		Date: Time : If your desired delivery time is not listed, please use a special requirement form to indicate your preference. We will try our best to accomodate your request.
Message :
Special Requirement:

Mrs. Flowers 19 Phaholyothin 21 Rd. Ladyao Jatujak Bangkok Thailand 10900
Tel. 662.930-3196 Fax. 662-930-3659
E-mail:mrsflowersinfo@yahoo.com

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