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I wish to send "Floral Boquet" as per details given below, Your charges for the same - Rs. 500/- Plus Service Tax shall be borne by me and can be collected from my address.

Mode of payment		Date of Delivery
	Cheque	Date
	Cash	Month
	Demand Draft	Year

I am sumbitting the necessary details which are mentioned below. Kindly confirm back the possibility of delivering the "Floral Boquet" to the consignee. I have read your terms and conditions and accept the same.

Sender's Details

Name:
Address:
City:
Pin code:
Telephone No:
Fax No:
E-Mail:

Consignee's Details

Name:
Address:
City:
Pin code:
Telephone No:
Fax No:
E-Mail:

Kindly note that the order has to be placed at least two working days in advance. The confirmation copy shall be mailed back to you on receipt of the payment.

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