Fax Order Form to Vita Int'l for Graceful Cradle fax (412) 564-9894

 

Shipping Address: Please print clearly.


Name: _________________________________________________


Street: _________________________________________________


City: __________________ State: _________ Zip: ______________


Home Phone    #: (______)_________________________________
Daytime Phone #: (______)_________________________________


Event Date: _______________   

E-mail address for fax confirmation: ________________________________
How did you hear about us? ______________________________________

If different than above... 
EXACT Billing Address: 

As is appears on your credit card statement.


Name: _________________________________________________


Street: _________________________________________________


City: __________________ State: _________ Zip: ______________


Credit card number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration date (month/year) __ __ /__ __        Card Code __ __ __


Number of Bouquet Displays with GRACEFUL CRADLE only _____________


Bouquet Display Total @ $8.00 $5.95 Each __________.___


Regular Shipping $2.75 for the First Bouquet Display __________.___
Regular Shipping $1.06 for Each Additional Display __________.___
Click Here for Priority and Express shipping details.

 

Priority shipping $4.00 additional __________.___


Express shipping $21.00 additional __________.___


Sub-total __________.___


PA residence only, 7% sales tax to total order __________.___


Total Order __________.___

                    With regular shipping, you will receive your order within two weeks. THANK YOU!

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