Mrs. Flowers' Request form

Mrs. Flowers' Request Form
Mrs. Flowers Tel. 662-930-3196 Fax 662-513-2961(auto 24hr.)
or e-mail us at MrsFlowersInfo@yahoo.com

Thank you for contacting us
We always try to do our best to fullfill you order. Right after recieving your form, our staff will try to accommodate your request and email you with the possibilities and the quotation. We answer our e-mail regularly both day and night.
Note Unless we recieve your confirmation after we e-mail you the info about the avialability and prices, we will not consider this a transaction. The information below is kept through this SSL form only for you convinience

Customer e-mail :

(required)

Special request:

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 :

SPECIAL!!!
Add your personal touch.Something special for him/her

Message :

Special Requirement:

Note :

Unless we recieve your confirmation after we e-mail you the info about the avialability and prices, we will not be charging your credit card. The information below is kept in this SSL form only for you convinience

Payment Method:

Credit Card Number:

For Visa and Master Card, please indicate the last three digit

Due to the new online regulation, Visa and Master Card has opted to require the last three digit of your credit card number. You can find them in the back of your card, printed on your signature pane

Card Holder's name:

Valid Thru:

(required)

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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