MORE INFORMATION

Same Day Delivery Available.

All major credit cards are accepted.

1742 Chislett St.
Pittsburgh, PA 15206

(412) 661-6071
(412) 687-4128
alexsflowers@aol.com
www.alexsflowers.com

SECURE ORDER & PAYMENT FORM

Your Name:
Your Billing Address:
City:
State/Province:
Zip/Postal Code:
Phone Number:
Your E-Mail Address:
(Complete e-mail address required)
How did you hear about us?
Place Your Order Here:
Recipient's Name:
Their Company (if business):
Recipient Address:
City:
State/Province:
Zip/Postal Code:
Recipient's Phone Number:
Delivery Date:
(For same day delivery in the Pittsburgh area,
order must be received by Noon)
Item(s) to be sent (Include dollar value desired for item to be sent. Delivery and tax will be added.): Tell us if any specific requests and we'll do our best.
Message for card:
(50 words max)
Do you have any comments or questions?
Make Payment Here:
Credit Card:
Name on Card:
Credit Card Number:
Expiration Date:
Are you making a payment for Wedding or Event?
Amount of Payment:
If above is NO leave this BLANK
(ONLY for WEDDING or EVENT)