Printable Mail Order Form

Printable Mail Order Form Print This Page CREATIVE FLOWERS 'N BUTTERFLIES
MAIL ORDER FORM

Items with * is required information.

BILLING ADDRESS	Mail Form To:
*Name:	Creative Flowers 'N Butterflies
*Street Address:	c/o Edwina Heath
Apt# or P.O. Box:	P.O. Box 6501
*City:	Villa Park, IL 60181
State: Zip Code:	PH: (630)-362-0463
Area Code: ( ) Phone Number: __________________ Email Address: __________________________________	Make Check or Money Order Payable to: Edwina Heath

SHIPPING ADDRESS

We will gladly ship your order to a different address. Please enter the address here. If ship to address is the same, leave this area blank.

Name:

Street Address: Apt# or P. O. Box:

City: State: Zip Code:

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Illinois Residence please add 5% Sales Tax. Allow 2 - 4 weeks for Domestic Delivery.
If Ship To address differs from Illinois Billing Address, sales tax is still applicable.

Priority Mail: Would you like your order shipped Priority Mail: [ ] YES [ ] NO

Subtotal	.
5% Sales Tax	.
Shipping	.
Total Amount	.

Customer Comments and Special Instructions
____________________________________________________________________________________________________
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*Method of Payment (choose one)
Credit Card: [ ] Mastercard [ ] Visa	[ ] Check [ ] Money Order
Name on Card:	Check Number: Account Number:
Account Number:	Transit Number:
Expiration Date:	Routing Number:
________________________________________ Your Signature	Bank Information Bank Name: _____________________________ Address: ______________________________ City: ________________ State: ______ Zip _______ Bank Phone: Area Code ( ) ____________________