|
Jurliss Order Form |
|
|
Notice |
|
This
order form should be filled up under the instructions of
Jurliss Flowers. |
| |
|
Please
contact us at 65 6275 8221 if there is any query. |
|
|
|
|
IE6
& above or FireFox2 is required to display this form properly. |
|
|
|
Product Information |
|
|
Description
|
* |
|
Product
Code
|
JFSpecial |
|
Payable Amount
|
|
|
|
|
|
Recipient
Information |
|
|
Country
|
|
|
Zone
/ State / City
|
Please
indicate the full address below
|
|
Address
|
*
|
|
Zip
/ Postal Code
|
*
|
|
Name
|
*
|
|
Tel
|
* Cell
Phone Number Prefered
|
|
E-mail
|
|
|
|
|
|
Delivery Date
& Time |
|
|
Month
|
*
|
|
Date
of the Month
|
* e.g.
31
|
|
Year
|
*
|
|
Time
|
|
|
|
|
|
|
|
|
Payment Information
|
|
|
Mode
of Payment
|
|
|
|
|
|
Sender
Information |
(For
our reference only. Will not be revealed.) |
|
Country
|
|
|
Address
|
|
|
Zip
/ Postal Code
|
|
|
Name
|
*
|
|
Tel
|
* Cell
Phone Number Prefered
|
|
E-mail
|
*
|
|
|
|
|
Salutation
|
e.g.
Dear Julie
|
|
Message to
Recipient
|
|
|
|
|
|
|
|
Number
of characters entered. Max. 225.
|
|
|
|
| Do
not use ['] & ["] in |
| the
message |
|
|
|
Sign off
|
|
|
|
|
|
Occasion
|
|
|
|
|
|
How
did you find us
|
|
| |
|
|
Notice |
|
This
order form should be filled up under the instructions of
Jurliss Flowers. |
| |
|
Please
contact us at 65 6275 8221 if there is any query. |
|
| |
|
|
IE6 & above or FireFox2 is
required.
|
| |
|
|
|
|
|