Incoming Fax Order
Toll Free: 1-800-873-2103____________________ Fax Number (315)-672-9758
Deliver
to:________________________________________________________
Address:_________________________________________________________
Phone:___________________________________________________________
Delivery
Date:_____________________________________________________
Delivery Instructions:_______________________________________________
First Choice:_______________________________________________________
Description:________________________________________________________
Price Including
Delivery:_____________________________________________
Card
Message:______________________________________________________
Occasion:___________________________________________________________
Special
Instructions:__________________________________________________
Customers
Name:____________________________________________________
Address:____________________________________________________________
Day Time Phone #:
_______________Evening Phone #: _____________________
E-Mail
Address:______________________________________________________
Credit Card # + Expiration
Date:________________________________________