Bill To Information: Date:            Name:  Phone1:   Phone 2: Email:                                      (For order contact purposes only)

Send To Information: Name:    Address: City:           State: . AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming     Zip:            Phone:

"All applicable delivery fees will be applied to total of flower order"

   Any additional information required :

Payment Information: (Please check one option)

   Option 1.  Personal Check              Option 2.  Credit Card  Visa     MasterCard    Discover Card

              Credit Card Number: ________________________________    Expiration . January February March April May June July August September October November December    . 2003 2004 2005 2006 2007 2008 2009 2010
                                                        For security, Credit Card number should be completed by hand after printing the form.  See below...
 

Option 1.  Click "Print" and mail the order sheet with a personal check or completed credit card information to:
Katies Flowers
201 East Main
Clarinda, Iowa  51632

Option 2.  Click "Print" and FAX the order with completed credit card information.  Please call (712) 542-6541
(800)551-6287 for our FAX number.

Option 3. Click "Submit" to send us your order via email.  Call to give us your credit card information to complete the order for processing.