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custom order form

To create your custom gift basket, just click on the items you require and we will design your gift.

Please include any additional requests in the text box at the end of the form.

Custom Order Form
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name*
E-mail Address*
Street Address*
City*
State/Prov*
Zip/Postal Code*
Country*
Business Phone*
Fax*
Required Items
Bear
Wine
Roses
Nuts (almonds, mixed) $10.00 ($7.60 USD)
Biscuits (crackers) $10.00 ($7.60 USD)
Balloons $20.00 ($15.20)
Color of Flowers
Shipping Address (if different from above)
Comments or Special Requests

Please enter the word that you see below.