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This Order Form is not Encrypted

Order Information :


Name of Recipient

Address (Street only)



Zip Code

Phone Number

Item Number of Merchandise

Name of Item

Price of Item

For Gift Creations by FTD

Select Occasion

Delivery Date


Gift Card Message: e.g. ( Happy Birthday) ( I Miss You )....

Gift Card Signature:   e.g. "Love,  Bill"


Credit Card Information

Credit Card Number Expiration Month:
Expiration Year:   

Name as appears on the Card

Full Name

Address you receive you Credit Card Statement at:




Zip Code

Telephone Number We Can Reach You If There Are Any Problems or Questions.

Phone Number

Your E-Mail Address



bulletFlower orders must be submitted the day before you wish it delivered.
bulletGift creations by FTD will be shipped the next day and delivered according to shipping method.
bulletIf you cannot submit your order the day before, please call our Toll Free Number 1-800-825-6763  to place your order.
bulletOrders received by Telephone before 11AM Central DST can be delivered the same day.
bulletWe will send a conformation of you order (with the total Price to be billed to your Credit Card) to you E-mail Address.
bulletIf you wish to talk to us on the phone call 1-800-825-6763
bulletIf you want to E-mail us

Hit Counter Hits on this page.

E-Mail Debbie 

E-Mail Jack 

Copyright    1999-2008,  Withers Place Publications,  All rights reserved.