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| Please email or call us to request our fax number. |
Phone (310) 231-7076 CUSTOMER ORDERING BASKET(S) (Allow 24 hrs.to receive your order & price confirmation) Delivery Date Requested ___________________________ Your Name _________________________________Email _______________________ (Work Phone)______________________ (Home Phone) _________________________ Company _________________________Business Type __________________________ Address _______________________________________________________________ ______________________________________________________________________ City ________________________ State ____________________Zip ______________ Credit Card Type ____ VISA ____ MC ____AMEX ____ Discover Cr. Card # ________________________________________Expiration Date ________ Recipient Name _______________________________________________________ (Work Phone) _______________________(Home Phone) _______________________ Deliver to Address ______________________________________________________ _____________________________________________________________________ City _________________________ State __________________Zip ______________ Customer message to Recipient __________________________________________ _____________________________________________________________________ Gift Basket Name Ordered ______________________________________________ Cost per basket $________________ X Quantity Ordered _________ = $ ____________________ Add taxes where appropriate $ ____________________ Add Shipping Charges ___(or) Delivery Charges___ (L.A. Area) $ ____________________ TOTAL DUE $ ____________________ |
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