WR-CCDEMO – Fun Services of South Florida

Step 1 of 3 - General Information

Date
Date Format: MM slash DD slash YYYY
School / Organization*
Contact Information
Contact Name*
First Last
Phone*
Email*
Billing/Shipping Information
Billing Address*
Street Address Address Line 2 City State ZIP Code
Shipping Address*
(NO P.O. BOX OR RESIDENTIAL ADDRESSES)

Same as Billing Address

Street Address Address Line 2 City State ZIP Code

Product Orders
Basic Assorted Roses Kit
400 Roses / Case
Price: $140.00
Standard Roses Kit
800 Roses / Case
Price: $270.00
Deluxe Roses Kit
1600 Roses / Case
Price: $512.00
Number of Case(s)
Number of Case(s)
Number of Case(s)
Total Cost ($140.00 / Case)
Total Cost ($270.00 / Case)
Total Cost ($512.00 / Case)
Sales Tax __%
Price: $0.00
Sales Tax __%
Price: $0.00
Sales Tax __%
Price: $0.00
FREE SHIPPING in Florida
* Outside FL, Shipping Cost on Invoice.
FREE SHIPPING in Florida
* Outside FL, Shipping Cost on Invoice.
FREE SHIPPING in Florida
* Outside FL, Shipping Cost on Invoice.
(A) Payment Due
(B) Payment Due
(C) Payment Due
Total Due
$0.00

Payment Options
Would you like to pay by?*
- Payable by Check
- Payable by Credit Card
Payment: Checks payable to Fun Services.
Please mail payment and original order form to
Fun Services 2881 NE 7th Ave Pompano Beach, FL 33064.
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Customer Acknowledge
Customer (Initial Here)*
Date*
Date Format: MM slash DD slash YYYY
Signature*
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