Colorbar.gif (4491 bytes)
Exotica Florist - The World is in Bloom!
Colorbar.gif (4491 bytes)

Please complete all sections of this order form.


FX1000 - Tower of Roses

Multiple Orders: To send this item to more than one recipient, or to order
different items, first submit this order. Then select the Next Order link.


Underlined fields are required.  Incomplete forms will not be processed.

Click here for more information about delivery policies and procedures.

Size of Item: Qty: Delivery Date:
       

 

Gift Card Message

(Maximum 120 characters)

Enter Message
eg."Happy Birthday!"

Gift Card
Signature:
eg. "Love, Bob"

Billing Information


First Name


Last Name

Billing Address

City

State/Province

Country

Zip/Postal Code

Email

Day Telephone

Ext

Evening Telephone

Fax

 

Credit Card

Credit Card Number

AMEX
Visa
MasterCard

Diners Club
CarteBlanche
Discover

Expiration:

Expiration:

 

Delivery Information
Recipient First Name

Recipient Last Name

 



Is recipient's address the same as the billing address?

Check if yes.If not, please complete the Delivery Information below.

 

We are unable to accept orders for Post Office Boxes or APO's.

 

Select One Residence Business Funeral Home
Hospital Other

 

Institution / Business Name

 

 

Address

 

 

City

 

State/Province

 

Zip/Postal Code

 

 

Country

 

Telephone Ext
(Phone numbers are required for all rural route addresses.)

 

Delivery Instructions


Please specify any delivery instructions. Requests for delivery at specific times of the day can be requested, but cannot be guaranteed.

 

Please Let Us Know...


How did you hear about Exotica Florist?

TV Ad Radio Ad Internet Ad
Search Engine Listing Flyer/Insert Newspaper/Magazine Ad
Billboard/Outdoor Ad Catalog Family/Friend
Other : (please explain)

 

Any suggestions?

Please inform me via email of special promotions or discounts.

Discount Club
    


I am registered with the Exotica Florist  Discount Club.
I get 10% off all flower and basket orders, and 15% off all orchid purchases!

 

    

Place Your Order

Please verify that all of the above information complete and accurate.

OR
Fax to: 619-338-4917.

OR
Print and mail to:
Exotica Florist
1335 5th Avenue
San Diego CA 92101

OR
Order by Phone:
619-338-8130
1-800-471-8334 Toll free (US and Canada only)


Next Order

 

Holiday Specials Anniversary Birthday Balloons Customer Favorites Funeral Fruit Baskets
Get Well Love & Romance New Baby Plants & Planters Roses Seasonal Flowers
Teddy Bears Tropical Breeze Home