Valentine's Day Order Form

• Your Name*
  First Name

  Last Name
• Your E-mail*
   
• Your Phone Number*
   
• Name of Individual Recieving Flowers*
  First Name

  Last Name
• Phone Number of Individual Recieving Flowers*
   
• Delivery Address
  Street Address

  Address Line 2

  City

  Province / State / Region

  Postal Code / Zip

  Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

  Country
• What would you like to Order?
  For custom orders or unpriced items, please specify the price you would like to spend in the 'Notes for Sarah' section.
  
  If you would like to order multiple of the same item, and they are going to the same address, please specify in the 'Notes for Sarah' section how many you would like.
  
  If you are ordering for multiple delivery locations, please do a separate order per delivery address.
  
  
  
  Wildflower Bouquet (cut flowers only)

  Wildflower Vase Arrangement

  Fresh Bouquet (cut flowers only)

  Vase Arrangement Short

  Vase Arrangement Tall

  Custom Order
• How much would you like to spend on your flowers? *
  GST (5%) amp; Delivery ($10) will be added on to your invoice.
• Notes for Sarah
  Any specific requests that you would like Sarah to know about for your order? If custom order, please let me know what your vision is.
  
  If you are ordering multiple of the same item, please specify here how many you would like.
  
• Message on card
• Delivery Date
  February 12 - Afternoon

  February 12 - Evening (after 5 pm)

  February 13 - Afternoon

  February 14 - Afternoon