Please print out this order form and FAX it to us at (361) 853-1477

basket(s) ordered	qty	price each	total
__________________________________	______	$___________	$__________
__________________________________	______	$___________	$__________
__________________________________	______	$___________	$__________
__________________________________	______	$___________	$__________
BALLOON Bouquets	qty	price each	total
__________________________________	______	$___________	$__________
__________________________________	______	$___________	$__________
__________________________________	______	$___________	$__________

customer name: _____________________________________________________

billing address: ____________________________________________________

city, state, zip: ____________________________________________	_____	_________
phone:  (_________)   _________________________________________
email: ______________________________________________________

credit card:     VISA  (    )     MasterCard  (   )     Discover (   ) Amex ( )

card number: ______________________________________   exp: _____/_____

desired delivery date: ____________________________

shipping method:    (   )   delivered (Nueces county only)

( ) morning ( ) afternoon

When the gift is shipped or delivered, you will receive an e-mail confirmation.

recipient name: ________________________________________________

shipping address: _____________________________________________

city, state, zip _________________________________	_____	_________
phone:  (_________)   _____________________________
email:   _____________________________________________

What would you like the card to say?