First Class Service order form

Stora Nygatan 17, 111 27 Stockholm, Sweden, phone +46[0]70 751 56 08, fax +46[0]8 34 69 39 
 
Please fill out this order form and send it via Internet or fax. All prices are inclusive Value Added Tax, messenger and service fee exluded delivery within less than 18 hours, when an additional fee of 150 SEK is charged.
*) indicates the fields which must be filled out.
 
 Order date:
This is what you have ordered:   
 
Product:  Special Bouquet (please specify, max. 100 letters)   
Price:  SEK *  
Date of delivery:*year/ *month/ *day    
morning afternoon		  
Purchaser 
Name:*
Company:  
Address:*
City and postal code:*
Country:*
Phone daytime:*
Phone evening:  
Email address:*

Payment 
(*You have to choose between invoice or credit card) 
 
Credit card customers Invoice customers
Payment via:  Customer no:  
Credit card no:  
Expire date:  year/ month
Recipient  
Name:  
Company:  
Address 1:*
Address 2:  
Postal code:   City:* 
Phone daytime:  
Phone evening:  
Door code:  
 
 
If the Recipient of the flowers is not available, can we:  
 leave the flowers at the door? Yes No 
 leave the flowers to a neighbour? Yes No 
 
Greetings: (4 rows of 68 characters)
 
 
 
 
Information to deliverer: (2 rows of 68 characters)
 
 
 
This order will be delivered on the given day if all information on the order is correct and your credit card payment is approved. If something is wrong we will try to contact you.

Please check up the form so that all necessary information fields are filled out.